Intraoperative Decision Making in Parathyroid Surgery.

This article reviews intraoperative decision making related to several important aspects of parathyroid surgery. These include how to systematically identify a missing gland, when to perform a unilateral versus bilateral exploration for cure, approaches to secondary hyperparathyroidism, management of familial hyperparathyroidism, and the treatment of parathyroid cancer. The management of intraoperative complications, such as recurrent laryngeal nerve injury and devascularization of parathyroid glands, also is discussed.

Evaluation of an Adrenal Incidentaloma.

Given the frequent use of cross-sectional imaging in medicine, adrenal masses are discovered at an increasing rate. Once detected, it is critical to ensure the patient undergoes the appropriate biochemical/hormonal workup to rule out any aberrant activity and ensure imaging features do not raise suspicion for a malignant neoplasm. Patients with hormonal overactivity, concerning size, and/or imaging characteristics must be referred for surgical consideration. For those not requiring adrenalectomy, it is important to determine which patients mandate follow-up to ensure no further growth or development of hormonal production. It is also critical to understand what is the appropriate follow-up.