Surgery Medical News about hyperparathyroidism

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Imaging for primary hyperparathyroidism--an evidence-based analysis
Langenbeck's Archives of Surgery, 07/14/09

Mihai R et al. - The authors found evidence at level III leading to recommendations at grade B, that sestamibi scintigraphy is a recommended first test, but that US by an experienced investigator may be an alternative. MIP may be performed when both tests are concordant, and in case of only one test being positive, unilateral exploration and use of intraoperative PTH measurements are recommended. Bilateral neck exploration is used when both tests are negative.

Exclusive Author Commentary
Per Hellman, 07/14/09

Although endocrine surgery practice today in many hospitals include minimal invasive parathryoidectomy (MIP), there has been very few randomized trials stsing that MIP is superior to the classical bilateral neck exploration. In addition, the increased sensitivites of ultrasound as well as sestamibi scintigraphy, and the available use of intraoperative PTH measurements make MIP even more accessible. These methods are wicely described in numerous reports in the literature, with somewhat scarce level of novelty as the list just increases. In the present review we have tried to identify the role of MIP, BNE, sestamibi scintigraphy and ultrasound for parathyroid surgery, and found evidence enough to make grade B recommendations, now being the official European Society of Endocrine Surgoens guidelines for this type of surgery.

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