SURGICAL-MANAGEMENT OF HYPERPARATHYROIDISM AT AN AIR-FORCE MEDICAL-CENTER

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.