Current Surgical Management of Sporadic Primary Hyperparathyroidism

Area of Science:

• Endocrinology
• Surgical Oncology

Background:

• Primary hyperparathyroidism (PHPT) management has evolved, with increasing diagnosis of asymptomatic and normocalcemic cases.
• Multiglandular involvement and improved imaging techniques are now better understood.

Purpose of the Study:

• To review the current management strategies for primary hyperparathyroidism.
• To highlight the role of parathyroidectomy as the definitive cure.
• To discuss advancements in surgical approaches and outcomes.

Main Methods:

• Review of current literature on PHPT management.
• Emphasis on diagnostic imaging and intraoperative parathyroid hormone (PTH) monitoring.
• Comparison of focused vs. bilateral parathyroidectomy approaches.

Main Results:

• Parathyroidectomy is recommended for all symptomatic and asymptomatic patients meeting guideline criteria.
• Focused surgery with imaging and PTH monitoring is effective for single-gland disease.
• Bilateral exploration is crucial for multiglandular disease, achieving >97% cure rates with low complications.

Conclusions:

• Surgical intervention offers significant improvements in bone mineral density, quality of life, and long-term survival.
• Optimizing localization strategies and understanding outcomes in emerging variants require further research.