Persistent and recurrent hyperparathyroidism - Attitude.

ABSTRACT

BACKGROUND: Despite parathyroidectomy represents the curative treatment for primary hyperparathyroidism (pHPT) in up to 98% of patients, persistent hyperparathyroidism (perHPT) and recurrent hyperparathyroidism (rHPT) rates are reported in 22% and 10%, respectively. Indications for reoperation must be balanced with the higher risk of postoperative complications. The aim of this review is summarizing the current evidence in terms of preoperative assessment and surgical approach in patients with perHPT and rHPT. METHODS: Operations for pHPT between 1997 and 2023 in our center were analyzed and patients with perHPT and rPTH at time of referral were included. RESULTS: Among 1730 parathyroidectomies for pHPT, 85 patients underwent revisional surgery. Eleven and 74 out of these 85 cases were due to perHPT and rHPT, respectively. CONCLUSIONS: Prior to reoperation, biochemical assessment and localization methods should always be performed to properly plan surgical strategy. Surgical experience represents the primary determinant in achieving effective disease control.