Diagnosis and management of primary hyperparathyroidism

Since the introduction of biochemical autoanalyzers primary hyperparathyroidism is no longer an uncommon diagnosis. The diagnosis is established by clinical evaluation and persistently elevated serum calcium and parathyroid hormone levels. Management of symptomatic primary hyperparathyroidism is relatively straightforward and the disease can be effectively treated with surgery. Most surgeons agree patients without previous neck operations need not undergo preoperative localization studies; in addition, they feel that bilateral neck exploration should be the rule. However, the management of primary hyperparathyroidism in the asymptomatic patient is controversial. In this paper the natural history, diagnosis, and management of primary hyperparathyroidism is reviewed.