4. Surgical aspects of the parathyroid gland

Question 1

Primary adenoma(s)

Answer 1

hyperplasia, carcinoma

Question 2

Secondary adenomas

Answer 2

malnutrition, vit.D3 deficit, chr.uraemia

Question 3

Tertiary adenomas

Answer 3

adenoma based on secondary hyperparathyroidism

Question 4

Preoperative localization methods of parathyroid adenomas

Answer 4

• US (5 MHz head) - biopsy
• Subtraction scintigraphy (technetium-thallium, technetium-sestamibi)
• 99 Tc sestamibi scintigraphy wash-out method - SPECT
• CT
• MRI
• Selective arteriography
• Selective venous sampling - PTH
• Methionin PET-CT
• Picture-fusion combining techniques: SPECT-CT

Question 5

Principles for parathyroid disease:

Answer 5

• 95% of pts have symptoms
• ALL pts will develop osteoporosis
• Disease will worsen with time
• Only one treatment: SURGERY – nearly all can be cured with a small intervention

Question 6

Different surgical approaches:

Answer 6

1. Bilateral exploration without localization diagnostic
2. Unilateral exploration after preoperative localization
3. Minimal access operation – pre- and intraoperative diagnostic procedures