Clinical features of primary hyperparathyroidism: preoperative localization and parathyroidectory

Abstract

The introduction of the multichannel autoanalyser made measurement of serum calcium concentrations easier, and led to a dramatic change in clinical presentations. The reliable methods such as computed tomography (CT), ultrasonography (US) and magnetic resonance imaging (MRI) for preoperative localization of abnormal parathyroid glands has long been sought to increase the cure rate of surgical treatment. We report the clinical feature of primary hyperparathyroidism (PHPT). Patients were classified into four stages in chronological order. The early patients (the first stage, 1970-1979) were mainly diagnosed in the treatment of urolithiasis. Approximately 20% of patients in the second stage (1980-1986) were symptom-free, and hypercalcemia was detected by autoanalyzer. Patients in the third stage (1987-1993) underwent preoperative localization studies including CT. scintigraphy, ultrasonography and MRI. The recent patients (the fourth stage, 1993-1999) were mostly treated in the present hospital. In the first stage, PHPT was an uncommon metabolic disorder hat was typically associated with nephrolithiasis and was two to three times more common in men than in women. In the second, third and fourth stages, PHPT is a common and often symptomless endocrine disorder. The ratio of male to female is decreasing, because men are dominant in stone-formers. Four parathyroid glands were searched carefully in the first and second stages, and unilateral cervical exploration was performed in some preoperatively localized parathyroid glands in the third and fourth stages.