Endocrine Abstracts

Much has been written on the attributes of preoperative localisation and minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism. A recent 'summary statement from a workshop on asymptomatic primary hyperparathyroidism: a perspective for the 21st century' (Bilezikian et al, 2002) suggested however that in experienced hands, conventional open parathyroidectomy with visualisation of all four glands was still the gold standard. In light of this we have carried out a retrospective survey of all patients who underwent open parathyroidectomy (without preoperative localisation) for primary hyperparathyroidism between 1995 and 2002. We reviewed the clinical and biochemical presentations and determined outcomes post-operatively.

A total of 249 patients were identified (188 (76%) women) who were operated on by 1 of 3 surgeons. Mean age was 64 (range 19-97) years with 85% of patients >50. The majority of patients were asymptomatic and 16% had nephrolithiasis. Mean (+/-SD) serum calcium at diagnosis was 2.97+/-0.33 mmol/L and PTH was elevated in 94%. Positive correlations were found between PTH and calcium concentrations pre-operatively (r=0.37, p<0.001) and also between PTH and adenoma weight (r=0.42, p<0.01). Normalisation of serum calcium was achieved in 94% after initial surgery. Of the 13 patients not cured, 12 underwent sestamibi scanning that was positive in 8. Subsequent surgery was successful in 10/13 giving an overall cure rate of 99%. Median length of hospital stay was 5 days. Post-operative hypocalcaemia occurred in 14%; other complications were rare (1%) and minor. There was no postoperative mortality.

The high success and low complication rates of open parathyroidectomy observed in this survey are typical of other large centres that have dedicated parathyroid surgeons. This study further supports the effectiveness of conventional open parathyroidectomy for primary hyperparathyroidism and highlights that preoperative localisation in a de novo setting is not obligatory to achieve excellent outcomes.