Background: The primary hyperparathyroidism (pHPT) is one of the most frequent metabolic diseases. Due to improvement in diagnostics it is a point of interest whether patients with pHPT still suffer from the typical symptoms. Moreover, the question of the best localisation-diagnostics and the most frequent localisation of the adenoma is not yet clarified. New operation strategies and more cost-efficient strategies for diagnostic and therapy could be developed due to the clinically established electrochemiluminescence immunoassay for intraoperative monitoring of intact parathyroid hormone (iPTH).
Patients and methods: 121 patients with pHPT were operated and retrospectively evaluated between November 1998 and September 2004. Apart from blood parameters, clinical symptoms were examined. As preoperative localisation techniques the ultrasound, the Tc-SestaMIBI scintigraphy, the CT scan and the MRI were used. The monitoring of the iPTH was performed with a special PTH-assay. The histological slices were estimated by a skilful pathologist.
Results: All patients showed an increased PTH level (> 65 ng / l). Nearly 50 % of the patients suffer from more than one symptom. Gastrointestinal- and neuromuscular symptoms were the most frequent symptoms. The best preoperative diagnostic procedure for localisation of the adenoma of the parathyroid gland, in non preoperated patients, seemed to be the combination of ultrasound and scintigraphy. The most common localisation of the adenoma was caudal, on the left side. Intraoperatively, we recognized in 28 from 34 patients an iPTH decrease of more than 50 % of the base value so that the operation could be finished as minimal invasive unilateral cervical exploration.
Conclusion: Patients suffering from pHPT should be treated in a centre with all diagnostic possibilities and surgical experience. Today, the combination of iPTH-monitoring and minimal invasive unilateral cervical exploration should be considered as standard in the surgery of the adrenal gland. Due to our data we recommend an exploration of the left caudal parathyroid gland first if the localisation of the adenoma could not be clarified preoperatively.