PRIMARY HYPERPARATHYROIDISM 1996

55 prospectively documented patients aged 20-84 (median 67) years (47 women, 8 males) underwent surgery for primary hyperparathyroidism (pHP T). The most frequent symptoms and associated conditions were nephroIi thiasis (42%) and neuropsychiatric symptoms (39%). Only one case of as ymptomatic and one Case of ''normocalcemic'' pHPT were found in this s eries. 47 patients (89%) were cured following initial neck exploration , and 3 further patients (6%) were cured by a second operation. Reoper ation also led to cure in 2 patients operated on elsewhere in the firs t instance. 6 patients (11%) had double adenoma (bilaterally) and 36% of the adenomas had an ectopic location, with an intrathyroidal adenom a in 2 cases. In 2 patients sternotomy was carried out. Persistent pHP T was observed in 3 patients (following initial exploration in 2 cases and reoperation in one). These patients had a supernumerary adenomato us gland with ectopic location in 2 cases and a double adenoma with ec topic position of one adenoma in a further case. One 80-year-old patie nt died postoperatively from intestinal ischemia. 2 patients had perma nent postoperative hypoparathyroidism; in no case was a permanent recu rrent laryngeal nerve palsy observed. Bilateral parathyroid exploratio n with thyroid mobilization by capsular dissection is the procedure of choice for pHPT. In 2 patients with the MEN 2A-syndrome and with medu llary thyroid carcinoma thyroidectomy. lymphadenectomy and autotranspl antation of normal parathyroids to the arm was performed, with normal parathyroid function in both cases.