Parathyroid pathology: Its relation to choice of operation for hyperparathyroidism

AbstractMultichannel autoanalyzers have diagnosed many unsuspected, largely asymptomatic cases of primary hyperparathyroidism. The age of onset of the disease and its rate of progression are not well understood. Surgical restoration of the eucalcemic state is associated with the healing of bone pathology, but many patients are not relieved of hypertensive or renal disease, and sometimes these problems continue to develop in the postoperative period, resulting in continued morbidity and mortality despite “successful” surgery. Conflicting opinions regarding the differentiation between parathyroid adenomas, hyperplasia, and normal glands appear to be resolving as newer data, both retrospective and prospective, reemphasize the pathologic importance of the clinically enlarged or abnormal glands. Parathyroid surgery for renal osteodystrophy of secondary hyperparathyroidism and for persisting hypercalcemia of tertiary hyperparathyroidism may be modified by autotransplantation. Carcinoma of the parathyroid glands is rare, but operative findings merit review. A variety of surgical approaches have been proposed. The surest method for restoring normal calcium levels with minimal permanent hypocalcemia is identification of 4 parathyroid glands and removal of those which are grossly abnormal. For patients with multiple endocrine adenomatosis or familial hyperparathyroidism, subtotal parathyroidectomy is preferred. Additional surgical guidelines are reviewed and the development of a parathyroid registry to ensure closer follow‐up is suggested.