Hyperparathyroidism. A review.

Hypercalcemia with and without clinical manifestation appears to be diagnosed with increasing frequency. If hypercalcemia persists with no other obvious reasons, hyperparathyroidism can be suspected with a high degree of certainty. Surgical treatment requires confidence, patience and a thorough knowledge of the embryologic peculiarities and anatomic variations of these glands. In 88 percent of our 71 patients, a solitary benign parathyroid adenoma was diagnosed by light microscopy. Parathyroid four-gland hyperplasia was found in 5.6 percent of the patients and multiple adenoma in 3 percent. The cause of hypercalcemia was not found in 3 percent. All patients treated with parathyroidectomy responded well, with calcium levels returning to normal. Our results confirm that this conservative approach to parathyroidectomy without multiple gland biopsy is the better and more acceptable method of dealing with hyperparathyroidism. Multiple gland dissection biopsy, chest exploration and parathyroid implantation are necessary only in very difficult cases.