Current issues in hyperparathyroidism.

There has been a shift in the referral patterns in recent years that has resulted in increasing numbers of patients being referred to surgeons with a diagnosis of hypercalcemia rather than primary hyperparathyroidism. The surgeon must perform a thorough history, including medications, and laboratory assessment, including serum calcium and parathyroid hormone measurements. A 24-hour urinary calcium excretion should be routinely ordered to exclude FHH. After the diagnosis of primary hyperparathyroidism is made, preoperative localization studies will benefit 78% to 90% of patients, with sestamibi scan being the most commonly used.