[Surgery of the parathyroid gland]

The introduction of various techniques for minimally invasive parathyroidectomy (MIP) has changed both the conceptual and surgical approach to parathyroid disease. The perceived advantages of minimally invasive surgery among both clinicians and patients have been a major factor in the development of new surgical techniques, as well as refinement of preoperative localization techniques such as high-sensitive ultrasound and technetium sestamibi scanning. MIP for primary hyperparathyroidism has become an accepted part of endocrine surgical practice worldwide. In recent years, medical management of hyperparathyroidism has been made possible with the use of therapeutics specifically aimed at the calcium-sensing receptor, a cell-surface protein widely viewed as the primary regulator of parathyroid hormone secretion. The calcimimetic agent cinacalcet is approved for the treatment of secondary hyperparathyroidism in patients with chronic kidney disease on dialysis and for the treatment of hypercalcemia in patients with parathyroid carcinoma. Cinacalcet is also expected to be useful in the treatment of intractable hypercalcemia in patients with primary hyperparathyroidism for whom parathyroidectomy is indicated but surgery is clinically inappropriate or contraindicated.