SURGICAL-TREATMENT FOR PRIMARY HYPERPARATHYROIDISM

Objective To document the recent surgical results in the treatment of primary hyperparathyroidism (HPT) at Queen Mary Hospital. Methods From 1995 to 1996, 30 patients underwent 31 operations for primary HPT. Th e data of 11 men and 19 women with ages ranging from 19 to 86 years (m edian: 57 years) were prospectively recorded with emphasis on the need of preoperative localization. Results Symptoms of hypercalcemia were present in 20 (67%) and complications in 17 (57%) patients, respective ly. Seventy-seven localization studies were performed in 28 patients ( average: 2. 6 tests/patient). Localization was accurate in 12 of 23 (5 2%) ultrasonographies, 11 of 26 (42%) CT scans and 16 of 27 (59%) scin tigraphies. Twenty-six patients had a single adenoma excised while 3 p atients with multiple endocrine neoplasia type I (MEN I) had subtotal parathyroidectomy for multiglandular hyperplasia during cervical explo ration. Immediate normocalcemia was achieved in 29 patients. One patie nt had persistent hypercalcemia due to a supernumerary fifth gland in the superior mediastinum that was successfully excised in a second ope ration. One patient had a unilateral vocal cord paralysis and 4 patien ts needed calcium supplement on discharge. During a median follow-up o f 5 months, all patients were normocalcemic with one requiring calcium supplements. Conclusion Surgical treatment for primary HPT is a safe procedure and is associated with a high success rate. In our experienc e routine preoperative localization study is not cost-effective.