OPERATIVE STRATEGY IN PERSISTING AND RECU RRENT PRIMARY HYPERPARATHYROIDISM

Persisting hypercalcemia after surgery for primary hyperparathyroidism is a challenge for the surgeon: once non-parathyroid causes for the h ypercalcemia have been excluded the only remaining possible causes are ineffective surgery and a failed surgery. Between 1986 and 1994, 414 patients with primary hyperparathyroidism were operated upon, 32 of wh om presented with persisting hypercalcemia; 24 of these patients had t heir first operation in another hospital. The cause for persisting hyp ercalcemia was a single adenoma in 27 patients (84%), double adenoma i n 2 patients and primary hyperplasia in 2 patients. In 1 patient an un successful revision operation was performed. In 17 patients the parath yroid glands had an atypical position. There were 11 patients who pres ented with recurrent hyperplasia. The reasons for recurrence were doub le adenoma in 2 patients and hyperplasia in 8 cases (73%). In 1 patien t no pathologic gland was found. Although preoperative localization st udies were positive in only 32%, the overall surgical success rate for tunately amounted to a satisfactory 95%.