Primary hyperparathyroidism. Preoperative evaluation and correlation with surgical findings

The clinical and operative findings in 101 patients with the diagnosis of primary hyperparathyroidism are reviewed, with particular emphasis on the current methods of preoperative evaluation.Of these patients seventy-two (72 per cent) underwent neck exploration. The twenty-nine patients who did not have an operation either refused operative treatment or were not granted an operation because of medical reasons (multiple system disease in elderly patients). Fourteen of the surgical patients (20 per cent) required re-exploration. Two patients had negative neck explorations.Preoperative evaluation included routine serum calcium (X3), serum phosphorus, and alkaline phosphatase determinations, and appropriate radiologic evaluation. Urinary cyclic AMP levels were helpful in differentiating primary hyperparathyroidism from nonparathyroid hypercalcemia.Phosphorus clearance studies were helpful as were twenty-four hour urinary calcium determinations. Parathyroid scans and arteriography were not helpful diagnostically and intravenous toluidine blue was of no benefit intraoperatively.Eleven patients had selective neck vein catheterizations for parathyroid hormone immunoassays with 63 per cent localization.Of seventy patients with positive surgical findings, eleven had chief cell hyperplasia, six had adenomatous hyperplasia, and fifty-three had adenoma(s).