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Surgery for primary hyperparathyroidism 1962-1996: indications and outcomes
L W Delbridge1, N A Younes, A I Guinea
1Department of Surgery, University of Sydney, NSW. leighd@med.su.oz.au
The Medical Journal of Australia
|March 21, 1998
Summary
Surgery for primary hyperparathyroidism is more common now, with low bone mineral density replacing kidney stones as the main reason for parathyroidectomy. Experienced surgeons achieve a 99% cure rate.
Area of Science:
- Endocrinology
- Surgical Oncology
- Neurosurgery
Background:
- Primary hyperparathyroidism (PHPT) is a common endocrine disorder.
- Historically, renal calculi were the primary indication for parathyroidectomy.
- Advances in biochemical screening and bone densitometry have altered disease presentation.
Purpose of the Study:
- To analyze trends in indications for PHPT surgery over three decades.
- To evaluate surgical outcomes for PHPT.
- To identify shifts in patient presentation and surgical management.
Main Methods:
- Prospective hospital database survey.
- Analysis of 733 patients undergoing neck exploration for PHPT.
- Data collected from January 1962 to December 1996 at a tertiary referral hospital.
Main Results:
- Annual parathyroidectomies increased exponentially from 2 to 73.
- Renal calculi were the main indication in the 1960s/70s (58%/43%).
- Asymptomatic disease (biochemical screening) rose in the 1980s (19%), and low bone mineral density became primary in the 1990s (31%).
- Overall surgical failure rate was 1%, with 99% cure rate.
Conclusions:
- Surgery for PHPT has become more frequent.
- Low bone mineral density is now the leading indication for parathyroidectomy.
- Expert surgical management ensures high cure rates for PHPT.