Intra-operative serum calcium monitoring compares favourably with parathyroid hormone monitoring to determine completeness of surgery for parathyroid adenoma

Abstract

Hyperparathyroidism (HPT) is a common endocrine disorder. The most common causes of primary HPT are parathyroid gland hyperplasia and adenoma. HPT results in hypercalcaemia which can result in serious complications including peptic ulcer diathesis, acute pancreatitis, nephrocalcinosis, nephrolithiasis and acute neurological disorders. However many patients remain symptomless or their complications are common disorders such as hypertension, mild neuropsychiatric disorders or osteoporosis which are not readily ascribed to hypercalcaemia. This latter group is usually diagnosed unexpectedly from hypercalcaemia noted on routine mass serum electrolyte measurements. Raised serum parathyroid hormone (PTH) level indicates the cause of hypercalaemia to be HPT. Hyperfunctioning enlarged parathyroid glands can be identified by ultrasonography and/or sestamibi scintigraphy. Surgery is the only definitive treatment for primary HPT. Current practice for parathyroid adenoma surgery is focused minimal access surgery after preoperative localisation with ultrasonography/sestamibi scintigraphy. Successful or complete adenoma excision is confirmed by a rapid fall of serum PTH.1 Minimal access parathyroid surgery affords patients a better quality of life compared to traditional bilateral neck exploration.