Volume 132, Issue 3 p. 359-372

A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003

James M. Ruda BS

James M. Ruda BS

Pennsylvania State College of Medicine, Penn State College of Medicine, Hershey, PA

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Christopher S. Hollenbeak PHD

Christopher S. Hollenbeak PHD

Departments of Surgery and Health Evaluation Sciences, Penn State College of Medicine, Hershey, PA

Department of Health Studies, Lehigh Valley Hospital, Allentown, PA

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Brendan C. Stack JR MD, FACS

Corresponding Author

Brendan C. Stack JR MD, FACS

Division of Otolaryngology-Head and Neck Surgery, Penn State College of Medicine, Hershey, PA

Reprint requests: Brendan C. Stack, Jr, MD, FACS, Penn State College of Medicine, PO Box 850, 500 University Drive, 4833, Hershey, PA 17033; e-mail, [email protected].Search for more papers by this author
First published: 17 May 2016
Citations: 23

Presented at the Annual Meeting of the American Academy of Otolarynogology–Head and Neck Surgery, Orlando, FL, September 21-24, 2003.



To systematically review the current preoperative diagnostic modalities, surgical treatments, and glandular pathologies associated with primary hyperparathyroidism.


A systematic literature review.


Of the 20,225 cases of primary hyperpara-thyroidism reported, solitary adenomas (SA), multiple gland hyperplasia disease (MGHD), double adenomas (DA), and parathyroid carcinomas (CAR) occurred in 88.90%, 5.74%, 4.14%, and 0.74% of cases respectively. Tc99m-sestamibi and ultrasound were 88.44% and 78.55% sensitive, respectively, for SA, 44.46% and 34.86% for MGHD, and 29.95% and 16.20% for DA, respectively. Postoperative normocalcemia was achieved in 96.66%, 95.25%, and 97.69% of patients offered minimally invasive radio-guided parathyroidectomy (MIRP), unilateral, and bilateral neck exploration (BNE). Intraoperative PTH assays (IOPTH) were helpful in approximately 60% of bilateral neck exploration conversion (BNEC) surgeries.


The overall prevalence of multiple gland disease (MGD and DA) was lower than often suggested by conventional wisdom. Furthermore, preoperative imaging was less accurate than it is often perceived for accurately imaging MGD. MIRP and UNE were more successful in achieving normo-calcemia than is typically quoted. IOPTH was a helpful but not “fool-proof” adjunct in parathyroid exploration surgery.


These results support a greater role for the treatment of primary hyperparathyroidism using less invasive approaches. EMB rating: B-3.