Surgical approach for parathyroid adenomas

Aim: Primary hyperparathyroidism is a clinical entity characterised by hypercalcemia due to excessive production of parathormone from parathyroid glands. In contrast to the patients who were diagnosed with serious bone symptoms and renal findings in the past; the most of the patients are recognised in asymptomatic stage to date. Surgical approach is curative in primary hyperparathyroidism due to adenoma, hyperplasia and carcinoma of parathyroid. In this study, retrospective evaluation of 57 patients was aimed in whom diagnosed, treated and surveilled with primary hyperthyroidism in our clinic for last 5 years.Materials and Methods: This study was performed on 57 patients who were treated for primary hyperparathyroidism in Çukurova University Medical Faculty, Department of General Surgery between January 2005 and December 2009. The ages, genders, compliants, and preoperative/postoperative laboratory findings of the patients were recorded. The efficiency of imaging techniques, operation findings and pathologic specimens were evaluated. Postoperative increment of bone mineral density was compared with the preoperative values.Results: The musculo-skeletal system complaints remain the leading complaints being 27 (47.4%) of the patients. A statistical significant reduction was detected in parathormone and calcium values in 1. day and 1. month of postoperative period when compared to preoperative values. Unilateral neck exploration was performed in 49 patients (86%), whereas bilateral neck exploration was performed in eight (14% patients). The lesion was in normal anatomic localization of 55 (96.5%) patients and anterior mediasten localized lesions were detected in two (3.5%) patients. Parathyroid adenoma was detected in 53 (93%), parathyroid hyperplasia in one (1.8%), parathyroid carcinoma in two (3.5%) patients were detected in histopathologic investigation. Hypocalcemia that occurred in 15 (26.3%) patients was the most frequent and lonely complication. The increment in bone mineral density of the patients which were performed preoperatively and postoperativeley was statistically significant.Conclusion: In this study, the patients who were detected to have an unilateral lesion by the guidance of preoperative imaging methods, unilateral neck exploration was found to be satisfying.