Chen, S Parkerson, R Udelsman (Johns Hopkins Hosp,
Parathyroidectomy in the elderly: Do the benefits outweigh the risks?
World J Surg 22:531-536, 1998.
The incidence of hyperparathyroidism (HPT) in the elderly is over 1.5%; parathyroidectomy is the treatment of choice in these patients.
Contrary to earlier series reporting high morbidity rates, significant mortality rates, and longer length of stay, elderly patients in this series who underwent parathyroidectomy experienced high cure rates, low morbidity, zero mortality, short length of stay, and high patient satisfaction. The benefits of surgery outweigh its risks.
- Song AU, Phillips TE, Edmond CV, et al (Lasky Clinic, Beverly Hills, Calif; Fort Rucker Army Hosp, Enterprise, Ala; Cascade ENT, Puyallup, Wash; et al)
Success of Preoperative Imaging and Unilateral Neck Exploration for Primary Hyperparathyroidism.
Otolaryngol Head Neck Surg 121: 393-397, 1999
Ninety-one patients of primary hyperparathyroidism were operated over a period of 6 yrs by 2 experienced surgeons.
Preoperative 99mTc sestamibi scanning is reliable in planning unilateral exploration. If one gland is enlarged, it is excised and the other gland biopsied. If none shows enlargement bilateral exploration is advised. Authors report cure rate of 90%.
Editor, R.A.Otto’s comment: Opponents of this approach feel that more than one adenomas are found and therefore preoperative imaging has limited value. With rapid intraoperative parathyroid hormone assays, this issue will be less important