PARATHYROID SURGERY AND AUTOTRANSPLANTATION

Since the introduction of the multichannel autoanalyzer into clinical medicine 25 years ago, primary hyperparathyroidism has become a common ly diagnosed disease. It affects approximately 1 of every 1000 individ uals, most of whom are postmenopausal females with minimal symptoms. A lmost all patients are managed surgically. The proper treatment is die macroscopic and microscopic identification of all four parathyroid gl ands followed by resection of those that are enlarged. The cure rate i s greater than 95% in the hands of an experienced endocrine surgeon. W hen all four parathyroid glands are enlarged, either a subtotal resect ion or a total parathyroidectomy with autotransplantation is performed . A failed operation resulting in either persistent or recurrent hyper parathyroidism presents a difficult management problem. Every effort m ust be made to identify the missed tumor by performing noninvasive, an d if necessary, invasive imaging procedures. The reoperative procedure s are difficult and time consuming and, compared to the initial explor ation, they are associated with a much greater morbidity.