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What steps should be considered in the patient who has had a negative cervical exploration for primary hyperparathyroidism?
Author(s) -
Harrison Barney
Publication year - 2009
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.2009.03597.x
Subject(s) - primary hyperparathyroidism , medicine , hyperparathyroidism , parathyroid gland , surgery , radiology , general surgery , parathyroid hormone , calcium
Summary The key to cure of the patient with persistent primary hyperparathyroidism is a clear understanding of the investigations, operative procedure and pathology related to the initial procedure. Reinvestigation and subsequent surgery should be performed in a specialist unit. A logical pathway of increasingly sophisticated localization studies (MIBI, ultrasound, CT/MRI, selective venous catheterization for PTH) will usually guide the surgeon to the missing parathyroid gland/s. Improved preoperative localization can facilitate the use of a minimally invasive small incision approach. The surgeon must have a detailed knowledge of the nuances of parathyroid embryology and a meticulous surgical technique, not only to identify and safely remove the retained gland/s but also do so without causing unnecessary morbidity. Results of re‐operation (84–98% cure) from centres of excellence are highly commendable, yet the use of ‘new’ technology (that includes intra‐operative PTH) has not translated into improved outcomes in all cases. Some parathyroid glands are extremely difficult to find! Re‐operative parathyroid surgery is a challenge, sometimes easy, and on other occasions extremely difficult.