Update on the management of parathyroid tumors

Parathyroid tumors are virtually always benign with an estimated incidence of parathyroid carcinoma causing hyperparathyroidism in only.017% of cases. Virtually all parathyroid neoplasms, including the rare parathyroid carcin oma, are functional and discussion of the management of parathyroid tumors is tantamount to the discussion of primary hyperparathyroidism, The biochem ical diagnostic criteria with rare exception is definitive, and the key iss ue with this functional benign endocrine neoplasm is when to recommend oper ation and how to ensure optimal results in this curable disease. Patients s ymptomatic with nephrolithiasis, significant osteoporosis, bone pain, and i n some cases constitutional symptoms should undergo a surgical therapy. Als o, patients with markedly abnormal laboratory values including a calcium 12 .0 mg/dL, or 24-hr urinary calcium >400 mg/day should be treated surgically . The sestamibi nuclear medicine scan has become the best tool available fo r imaging of abnormal parathyroid glands. This study is positive between 60 % and 90% of initial operations and in between 40% and 70% of reoperations. For multi-gland parathyroid disease or hyperplasia, the sensitivity of thi s test is decreased. Understanding of the ectopic locations of parathyroid adenoma is of utmost importance in the conduct of the parathyroidectomy, Fo r the rare patients with parathyroid carcinoma, aggressive surgical resecti on with en bloc removal of any adjacent invading structures is the best cha nce for cure leading to 10-year survival rates of 49%. (C) 2000 Lippincott Williams & Wilkins, Inc.