[Direct exeresis of adenoma of the parathyroid glands]

The only therapy for primary hyperparathyroidism (PHPT) is total surgical removal of all parathyroid tissue responsible for hypersecretion. The biggest difficulty for such treatment is the preoperative differential diagnosis between simple parathyroid adenoma (incidence up to 85-90% of PHPT) and diffuse gland hyperplasia (incidence up to 50% of PHPT). Total removal of all parathyroid tissue is not only needless if the aetiology of the syndrome is a simple adenoma, but moreover it is responsible of a completely unnecessary and deeply disabling hypoparathyroidism. It is therefore of the utmost importance to make any preoperative effort for an accurate aetiological diagnosis, and to try the exact localization of the eventually responsible adenoma with all modern diagnostic tools. In spite of any preoperative effort very often the resolution of such problem must be relied to the surgical exploration of all sites of possible hyperplastic gland, with intraoperative hystological study of multiple biopsies. But only a relative help comes from peroperative biopsy, because it is not so easy to reach intraoperatively an hystological certainty in discriminating between hyperplastic and adenomatous tissue on fresh specimens. In the case report a single adenoma of the right lower parathyroid was localized preoperatively with combined researches, mainly with echography, and its surgical removal demonstrated curative at all. The massive lithiasis of left residual kidney was then successfully treated by shock waves. Echography can give therefore a relevant help in preoperative diagnostics of a parathyroid adenoma; is foreseeable its useful employment also intraoperatively, avoiding so an extensive bilateral dissection of all parathyroid sites, responsible of postoperative scarring that hinders any postoperative morphological control and makes dangerous any neck reintervention.