Management of hyperparathyroidism: a five year surgical experience.

OBJECTIVE To summarize the management of hyperparathyroidism at a tertiary care hospital in Lahore, so that the disease characteristics specific to our population could be identified. Also to determine if focused parathyroidectomy was successful without intra operative localization studies. METHODS Retrospective analysis was conducted on all cases of hyperparathyroidism, managed at the East Surgical Ward, Mayo Hospital, Lahore, during a five year period (2005-2009). RESULTS Thirty-two cases of primary hyperparathyroidism and 3 cases of secondary hyperparathyroidism were managed at the East Surgical Ward from 2004-2009. For primary hyperparathyroidism the mean age of presentation was 40.78 +/- 15.42 years and the mean duration of symptoms was 33.96 +/- 27.29 months. Advanced musculoskeletal symptoms were the most common presenting feature followed by gastrointestinal complaints and recurrent renal stones. Unilateral neck exploration and excision of adenoma was carried out successfully in all cases where the results of ultrasound neck and technetium-99m sestamibi scan were concordant. Bilateral neck exploration was performed in all other cases. Decreased serum calcium level was achieved post operatively in all cases and no residual disease or recurrence was encountered on follow up. CONCLUSION Patients of hyperparathyroidism in our country, tend to present late after the development of complications. Pre operative localization studies like ultrasound neck and sestamibi scan have enabled us to carry out directed exploration rather than bilateral neck exploration in every case. Accurate pre operative assessment and safe surgery offers cure to all patients with primary hyperparathyroidism.