B2. Hyperparathyroidism.

Page created on October 11, 2021. Not updated since.


For introduction, pathology, and etiology, see the corresponding pathology 2 topic. For clinical features, diagnosis and evaluation, and non-surgical treatment, see topic 42 of internal medicine final.

Surgical treatment of hyperparathyroidism

For primary hyperparathyroidism, surgery is the only definitive treatment. However, it’s not recommended for everyone. Surgery is generally indicated for:

  • Serum calcium > 2,8 mM
  • Deteriorating kidney function
  • Young patient

If surgery is not indicated, the patient is monitored regularly for progression.

For patients with indication for surgery but who are unable to have surgery, medical therapy with cinacalcet is an option. See the internal medicine topic for details.

Surgery is successful in almost all cases. The specific surgical treatment depends on the etiology:

  • Adenoma – extirpation (parathyroidectomy)
  • Hyperplasia – subtotal parathyroidectomy or total extirpation with autotransplantation
  • Carcinoma – extirpation + lymphatic block dissection

Autotransplantation refers to reimplantation of half of one of the resected glands in the forearm or neck muscle. This prevents total loss of PTH and allows for easy surgical access if this reimplanted gland causes problems later.

Secondary hyperparathyroidism is mostly treated conservatively, but surgery is indicated for severe refractory secondary hyperparathyroidism.

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