Peristent or Recurrent Hyperparathyroidism1

Question 1

What is persistent hyperparathyroidism?

Answer 1

Continuation or redevelopment of HPT within 6 months of parathyroid exploration, and it is usually the result of inadequate resection during the previous operation.

Question 2

What is recurrent hyperparathyroidism and what can cause it?

Answer 2

Development of HPT more than 6 months after successful parathyroid surgery, and it results from the development of hyperfunctioning parathyroid tissue. Causative lesions include recurrent parathyroid adenoma, hyperplasia, carcinoma, and parathyromatosis, a rare condition in which seeding and subsequent growth of aberrant parathyroid cells occurs after contamination of the operative field during previous parathyroid surgery.ﾠ

Question 3

Where can you find ectopic parathyroid glands?

Answer 3

Mediastinum/thymus, carotid sheath, adjacent to the cervical vertebral bodies, and within the thyroid gland

Question 4

What percentage of the population can have supernumerary parathyroid glands?

Answer 4

Approximately 8%

Question 5

What is the test of choice to diagnosed patients with familial hypocalciuric hypercalcemia?

Answer 5

24-hour urinary calcium measurements, as values less than 30 mg are suggestive of familial hypocalciuric hypercalcemia, a benign condition for which operative intervention is rarely indicated.

Question 6

What are the indications for surgical tratment in asymptomatic patients with persistent or recurrent hyperparathyroidism?

Answer 6

1. Total serum calcium greater than 1.0 mg/dL (0.25 mmol/L) above the upper limit of normal
2. Creatinine clearance less than 60 mL/min
3. Bone mineral density T score ?2.5 at any site and/or previous fragility fracture
4. Age <50 years
5. Inability or unwillingness to comply with biannual biochemical surveillance

Question 7

What is the most important about reoperating for hyperparathyroidism?

Answer 7

Locating the glands!!!

Question 8

What is the most common symptom of unilateral and bilateral recurrent laryngeal nerve injury?

Answer 8

Unilateral RLN injury can result in hoarseness, and bilateral RLN dysfunction can cause airway obstruction. RLN injury should be anticipated, and the surgeon should be present during extubation to assist with airway management.