[Surgical indications of primary hyperparathyroidism]

Clinical profile of primary hyperparathyroidism (PHPT) had shifted from symptomatic disorder, with hypercalcemic symptoms, kidney stones, overt bone disease, or a specific neuromuscular dysfunction toward a more asymptomatic state. Patients with symptomatic PHPT absolutely require parathyroidectomy (PTX). Surgical treatment is the well established and definitive treatment for PHPT. Consensus Conference at National Institute of Health (NIH) proposed the guidelines for PTX in asymptomatic PHPT. They included (1) serum calcium level was 1.0 mg/dL above upper limit of normal, (2) 24-h urinary calcium was over 400 mg, (3) creatinine clearance is reduced by 30%, (4) bone mineral density (T-score) reduced 2.5 SD below the peak bone mass at any site, and (5) patients under 50 years of age, and (6) patients for whom medical surveillance was either not desirable or not possible. Because in about 25% of patients asymptomatic PHPT will show progression, because it is important to monitor patients who are not undergoing PTX. Normocalcemic PHPT has been frequently found in patients whose bone mineral density is reduced. This diagnostic consideration requires that all potential causes of secondary HPT. The surgical procedure has been progressive induced by the developments of preoperative image diagnosis and intraoperative PTH assay. Minimally invasive PTX could expand surgical indications in patients with mild asymptomatic PHPT.