Primary hyperparathyroidism: controversies in surgical management

Controversy surrounds the optimal management of patients with mild or asymptomatic primary hyperparathyroidism (PHPT). Although many new medical therapies for this disorder have emerged in the past decade, existing evidence indicates that parathyroidectomy is the only curative option and reverses not only many of the classic, but also the more subtle, manifestations of PHPT. Moreover, parathyroidectomy can be performed successfully with minimal morbidity by experienced surgeons. With the recent development and widespread use of several preoperative localization studies, various focused approaches to neck exploration and intraoperative parathyroid hormone testing, management for this disorder will need to be tailored to individual patients.