Endocrine Abstracts

Surgical therapy of the primary hyperparathyroidism (PHP) offers a definite and curative treatment. The cooperation with an experienced endocrinologist is necessary, because the confidence that the patient has a PHP, is the primary presumption for the proper surgical therapy of the PHP. The result of a parathyroidectomy depends mainly on preoperative localization of hyperfunctional tissue and the experience of the surgeon. The parathyroidectomy remains curative approach in 97% of patients if provided by an experienced surgeon. The neck ultrasonography and MIBI scintigraphy of parathyroid glands remain the gold standards in preoperative imaging. The surgeon must but be able to perform a parathyroidectomy in case where preoperative localizing methods are not successful. In addition, we require an indication to surgical approach in patient with concomitant thyreopathy. The basic technique of a parathyroidectomy is the bilateral exploration of the neck with the examination of all locations of the parathyroid glands, including ectopic ones, usually from the collar skin incision above the jugulum.

In terms of a minimalization of surgical approach, unilateral, radionavigated and miniinvasive approaches were developed. In case of intrathoracic-mediastinal localization of parathyroid glands, the partial median sternotomy is the basic approach. In 3.5% of 680 our patients, the neck approach was not sufficient. The complications of parathyroidectomy are not common. They include the hypoparathyroidism and the recurrent laryngeal nerve injury with following vocal cord paralysis. Benefits To date, the parathyroidectomy is a short, one-day surgery operation in surgical centers. The improvement of surgical technique offers a surgical treatment to ”asymptomatic“ patients. In case of a clear localization of parathyroid adenoma by sonography or MIBI scintigraphy, the operation is short, safe and does not stress the patient. In these patients, the so-called small symptoms (fatigue, musculoskeletal pain, weakness, dyspepsia, polydypsia, constipation, polyuria, pruritus, depression) are ameliorated.

Supported by IGA MZ ČR č. 8308-5/2005