[Surgical treatment of asymptomatic primary hyperparathyroidism]

To discuss the diagnosis and management of asymptomatic primary hyperparathyroidism (PHPT).

Clinical data of 46 cases of primary hyperparathyroidism from January 1990 to December 2006 were retrospectively analyzed. There were 5 cases of asymptomatic PHPT. Three out of the 5 cases obtained the diagnosis by routine health examination and 1 case was misdiagnosed as thyroid tumor before surgery, but was conformed as parathyroid adenoma by intraoperative biopsy. Remaining 1 case was diagnosed because of weakness. The serum calcium and the parathyroid hormone (PTH) levels were elevated in 4 cases, while only 1 being normal range. Unilateral neck exploration was performed in all 5 cases.

There were no operational death, recurrent nerve injury or other complications. All patients had the same pathological diagnosis as parathyroid adenomas. Three cases showed gentle circumoral paresthesia after surgery with normal serum level of calcium, but the symptoms were relieved with oral use of calcium gluconate. Only 1 patient had tetany with the lowest level of serum calcemia at 1.96 mmol/L in 24 h postoperatively. The signs and symptoms were all relieved by intravenous use of calcium gluconate for 3 d after surgery. Remaining 1 case has normal level of serum calcemia after surgery. Time range of following-up for 4 cases was from 2 months to 2 years. The level of serum calcemia was normal for them. One lost following-up.

Asymptomatic primary hyperparathyroidism could be diagnosed according to co-elevated serum calcemia and PTH without typical symptoms. Unilateral neck exploration was the best choice for the patients with accurate imaging localization. Conservative management including adequate hydration, dietary calcium intake and pharmacological approaches could be used for the patients who were unfit for surgery.