Subtotal Glandectomy in Hyperparathyroidism

  • Mehmet Uludağ
  • Nurcihan Aygün


Hypercalcemia was detected in a 52-year-old female while being investigated because of recurrent renal stones. Metabolic profile revealed hypercalcemia with hypophosphatemia and elevated parathyroid hormone level. No pathological focus was demonstrated neither on neck ultrasonography nor 99mTechnetium-MIBI scintigraphy with single-photon emission computed tomography. Bilateral neck exploration was performed with the diagnosis of primary hyperparathyroidism (pHPT). All four parathyroid glands were observed to be enlarged during the exploration. Subtotal parathyroidectomy (sPTX) was performed. PHPT is a common endocrine disorder characterized by the excess production of PTH, resulting in the dysregulation of calcium metabolism. The diagnosis of pHPT is established due to biochemical examination. Imaging studies are not used to confirm the diagnosis but should be used for localization of the pathologic glands and determine the surgical strategy. Negative preoperative localization studies are highly predictive of multiglandular disease (MGD) in sporadic pHPT. Parathyroidectomy is indicated for all symptomatic patients and should be considered for most of the asymptomatic patients. MGD may not be excluded before surgery. The possibility of MGD in pHPT should always be kept in mind. sPTX is the standard treatment approach for patients with sporadic pHPT, whose all parathyroid glands are enlarged.


Primary hyperparathyroidism Multiglandular disease Bilateral neck exploration Subtotal parathyroidectomy Negative preoperative imaging 


  1. 1.
    Felger EA, Kandil E. Primary hyperparathyroidism. Otolaryngol Clin N Am. 2010;43:417–32. Scholar
  2. 2.
    Yeh MW, Ituarte PH, Zhou HC, Nishimoto S, Liu IL, Harari A, et al. Incidence and prevalence of primary hyperparathyroidism in a racially mixed population. J Clin Endocrinol Metab. 2013;98:1122–9. Scholar
  3. 3.
    Bilezikian JP, Brandi ML, Eastell R, Silverberg SJ, Udelsman R, Marcocci C, et al. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. J Clin Endocrinol Metab. 2014;99:3561–9. Scholar
  4. 4.
    Wu JX, Yeh MW. Asymptomatic primary hyperparathyroidism. Diagnostic pitfalls and surgical intervention. Surg Oncol Clin N Am. 2016;25:77–90. Scholar
  5. 5.
    Barczyński M, Bränström R, Dionigi G, Mihai R. Sporadic multiple parathyroid gland disease—a consensus report of the European Society of Endocrine Surgeons (ESES). Langenbeck’s Arch Surg. 2015;400:887–905. Scholar
  6. 6.
    Iacobone M, Carnaille B, Palazzo FF, Vriens M. Hereditary hyperparathyroidism—a consensus report of the European Society of Endocrine Surgeons (ESES). Langenbeck’s Arch Surg. 2015;400:867–86. Scholar
  7. 7.
    Siperstein A, Berber E, Barbosa GF, Tsinberg M, Greene AB, Mitchell J, Milas M. Predicting the success of limited exploration for primary hyperparathyroidism using ultrasound, sestamibi, and intraoperative parathyroid hormone: analysis of 1158 cases. Ann Surg. 2008;248:420–8. Scholar
  8. 8.
    Elaraj D, Sturgeon C. Operative treatment of primary hyperparathyroidism: balancing cost-effectiveness with successful outcomes. Surg Clin North Am. 2014;9:607–23. Scholar
  9. 9.
    Callender GG, Udelsman R. Surgery for primary hyperparathyroidism. Cancer. 2014;120:3602–16. Scholar
  10. 10.
    Wilhelm SM, Wang TS, Ruan DT, Lee JA, Asa SL, Duh QY, et al. The American Association of Endocrine Surgeons guidelines for definitive management of primary hyperparathyroidism. JAMA Surg. 2016;151:959–68. Scholar
  11. 11.
    Sebag F, Hubbard JG, Maweja S, Misso C, Tardivet L, Henry JF. Negative preoperative localization studies are highly predictive of multiglandular disease in sporadic primary hyperparathyroidism. Surgery. 2003;134:1038–41.CrossRefGoogle Scholar
  12. 12.
    Khan AA, Hanley DA, Rizzoli R, Bollerslev J, Young JE, Rejnmark L, et al. Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus. Osteoporos Int. 2017;28:1–19. Scholar
  13. 13.
    Moalem J, Guerrero M, Kebebew E. Bilateral neck exploration in primary hyperparathyroidism--when is it selected and how is it performed? World J Surg. 2009;33:2282–91. Scholar
  14. 14.
    Lorenz K, Bartsch DK, Sancho JJ, Guigard S, Triponez F. Surgical management of secondary hyperparathyroidism in chronic kidney disease--a consensus report of the European Society of Endocrine Surgeons. Langenbeck’s Arch Surg. 2015;400:907–27. Scholar

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© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Mehmet Uludağ
    • 1
  • Nurcihan Aygün
    • 1
  1. 1.Şişli Hamidiye Etfal Training and Research Hospital, Department of General SurgeryIstanbulTurkey

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