Surgical approaches to primary hyperparathyroidism

Primary hyperparathyroidism (HPT) is a common disease that can be diagnosed with nearly 100% accuracy. Surgical therapy is the only definitive cure for this disease, and normocalcemia can be achieved in 95% of patients who are cared for by an experienced surgeon at initial operation. Although a debate exists regarding the need for surgery in asymptomatic patients, the authors believe that the benefits of surgery, including improvement in symptoms and associated complications, warrant surgical intervention in nearly all patients; nonoperative therapy is reserved for older patients with multiple comorbid conditions and minimal hypercalcemia and clinical manifestations. In this article, the authors discuss the natural history of primary HPT, a cost-effective method of diagnosis, the indications for surgical therapy, the appropriate use of preoperative localization studies, the surgical approaches, and the long-term benefits versus risks of surgery.