Hyperparathyroidism: current concepts in diagnosis and surgical treatment

Hyperparathyroidism (HPT) is a complex endocrine disorder characterized by the dysregulated secretion of parathyroid hormone (PTH), leading to significant disruptions in calcium and phosphate homeostasis. This review provides a comprehensive analysis of the condition, beginning with the distinct clinical and biochemical profiles of its primary, secondary, and tertiary forms. It critically examines the evolving diagnostic pathways and the refined indications for surgical intervention, which remains the only curative treatment for primary HPT and a crucial therapy for advanced secondary and tertiary disease. Central to the discussion is a detailed exploration of modern surgical strategies, highlighting the paradigm shift from traditional bilateral neck exploration to precision-focused, minimally invasive parathyroidectomy, enabled by advanced preoperative localization and intraoperative PTH monitoring. The review further considers outcomes, postoperative management, and emerging techniques, including remote-access endoscopic approaches. By synthesizing current evidence and guidelines, this work aims to delineate a holistic framework for the effective management of HPT, from accurate diagnosis through to the selection and execution of the optimal surgical treatment strategy.