Current Surgical Management of Sporadic Primary Hyperparathyroidism

The management of primary hyperparathyroidism (PHPT) has evolved with increased recognition of asymptomatic and normocalcemic disease, improved imaging, and greater understanding of multiglandular involvement. Parathyroidectomy remains the only definitive cure and is now recommended for all symptomatic and asymptomatic patients meeting guideline criteria. Focused parathyroidectomy guided by dual-modality imaging and intraoperative PTH monitoring is effective for single-gland disease, while bilateral exploration is essential for in cases of multiglandular disease. Cure rates exceed 97% in experienced hands, with low complication rates. Surgery leads to improvements in bone mineral density, quality of life, and long-term survival. Ongoing research is needed to optimize localization strategies and define outcomes in emerging disease variants.