SURGICAL RESULTS OF THERAPY FOR ASYMPTOMA TIC PRIMARY HYPERPARATHYROIDISM

Surgery for symptomatic hyperparathyroidism remains the standard thera py. Asymptomatic primary hyperparathyroidsm (pHPT) is being diagnosed with increasing frequency owing to broad serum testing. Indications fo r surgery in this setting are controversial. For evaluation of surgica l safety we performed a retrospective analysis of our patients who wer e being operated on for asymptomatic pHPT. From January 1988 until Aug ust 1995, 243 patients were treated for pHPT and registered prospectiv ely at our unit. Seventy-six patients were classified as asymptomatic. In all, 75% of the patients were female; the mean age was 62 years. I n this group, 87% of the patients had cervical sonography in order to localize the adenoma. Highly selective venous catheterization was requ ired in cervical reexplorations. Statistical analysis for potential pr ognostic factors for the clinical outcome was performed. Successful ce rvical exploration was possible in 71 patients (94.7%). With 4 patient s remaining hypercalcemic, the rate of persistency was 5.2%. Localizat ion procedures were correct in 58% for cervical ultrasound and 77% for selective venous catheterization. Postoperative morbidity included on e permanent recurrent laryngeal nerve palsy and 2 patients with hemorr hage who were treated by reoperation. While one case of permanent hypo parathyroidism was well controlled by oral supplementation, 18 patient s recovered from temporary hypoparathyroidism. No postoperative mortal ity occurred. Risk factor analysis revealed only cervical reexploratio ns for HPT to be associated with a higher morbidity (P = 0.02). Surger y for asymptomatic pHPT can be performed with reasonable safety. Cervi cal reexplorations in asymptomatic patients should be reserved for spe cial indications. Apart from this small group, all patients should be evaluated for surgery.