The Landmark Series: Management of Primary Hyperparathyroidism

Surgery is the only definitive treatment for primary hyperparathyroidism (PHPT). The surgical management of PHPT has evolved over the past several decades in response to the continually growing body of evidence supporting its effectiveness in both symptomatic and asymptomatic disease. As imaging modalities for localization, operative approach, and intraoperative adjuncts, such as intraoperative parathyroid hormone testing, have been optimized, careful evaluation of the timing of parathyroidectomy in relationship to the disease's natural history has been pursued to limit the detrimental end-organ effects of untreated PHPT. Herein, we review select studies examining key aspects of PHPT management fundamental to the practicing surgical oncologist and endocrine surgeon caring for patients with PHPT.