Parathyroidectomy in primary hyperparathyroidism: retrospective study of 167 patients, experience in Jules Bordet...

The aim of this study is to compare our surgical results of parathyroidectomies in primary hyperparathyroidism with literature results. From 1985 until 2009, 167 patients were operated for primary hyperparathyroidism by bilateral central neck exploration. The sex ratio (women/men) is 4/1 and the middle age is 57 years old. We record clinical information, laboratory and radiological results of the preoperative period. We count 158 adenomas, 5 parathyroid hyperplasias, two carcinomas and two parathyroid glands reported as normal. The morbidity rate was low (0.6%) and there was no mortality. With a mean follow-up of 6 years, the majority of symptoms and clinical signs improved after surgery, the parathyroid hormone level (PTH) and the calcaemia normalized in all patients except 4/166 (2.41%). Among twenty-four patients who go for a Dual-Energy X-ray Absorptiometry test (DEXA), 16/24 (66.67%) demonstrated a lumbar spine bone mass increase and 15/24 (62.5%) a total hip bone mass increase. There was one recurrence of hyperparathyroidism due to a missed second adenoma in the mediastinum. In conclusion, the parathyroidectomy by bilateral neck exploration under general anesthesia in the treatment of primary hyperparathyroidism is a surgical technique associated with a high recovery rate and a low complications rate. A systematic study of the bone mass before and after parathyroidectomy should allow identification of the factors that are associated with the bone density increase of these patients.