A critical determinant of successful neck exploration for primary hype
rparathyroidism (HPT) is the experience of the surgeon. Results of 17
patients treated surgically for HPT were reviewed to compare results a
t our medical center with results of large series reported from establ
ished national centers. Preoperative laboratory evaluation of 15 patie
nts with surgically proven HPT (solitary adenoma, 14; diffuse hyperpla
sia, 1) included: mean serum calcium (Ca) 10.9 mg/dl +/- 0.79 and mean
serum chloride/phosphate ratio 39 mg/dl +/- 7.9. Serum parathyroid ho
rmone (PTH) was elevated in all patients. Seven neck ultrasounds were
performed with a positive predictive value of 42%. No significant oper
ative complications occurred. Mean postoperative serum Ca was 8.34 mg/
dl +/- 0.75. One patient had asymptomatic hypocalcemia (Ca = 6.5 mg/dl
). Follow-up in II patients (65%) at a mean of 8.6 months revealed no
evidence of recurrence in these patients. In our experience, proper pa
tient selection and careful surgical technique within established prin
ciples for neck exploration and parathyroidectomy lead to excellent re
sults despite the size of the medical center. Patient selection is bas
ed on serum Ca, PTH, and chloride/phosphate ratio. Preoperative imagin
g studies did not appear to be of benefit in the small study reported
here.