Update on Diagnosis and Management of Primary Hyperparathyroidism

Abstract

Program Description: The diagnosis and management of primary hyperparathyroidism is generally straightforward. Cases referred from endocrinologists for surgery will usually have the classic laboratory findings and the correct diagnosis. An adenoma will be localized by imaging in approximately 80% to 85% of these patients. As increasing referrals are being generated from primary care physicians rather than endocrinologists, surgeons will invariably see only partially worked up patients and diagnostic dilemmas. The first part of this panel, which is composed of expert endocrine surgeons with extensive experience in parathyroid surgery, will address some of the diagnostic challenges and their evaluation. The second portion of the panel will focus on treatment. Minimally invasive parathyroidectomy (MIP) has become the preferred surgical approach for treatment of primary hyperparathyroidism. Localization of an adenoma on preoperative imaging is the key to being able to perform a successful MIP. The panel will discuss pearls and pitfalls in the imaging of parathyroid adenomas, including the use of ultrasound, sestamibi parathyroid scan, and CT scans. Thirdly the panel will present state of the art minimally invasive parathyroidectomy techniques, such as radioguided surgery, lateral approach, performing MIP under local/sedation. Cases will also be presented on how to approach failed explorations.

Educational Objectives: 1) Learn pearls and recognize pitfalls of challenging cases of hyperparathyroidism. 2) Understand the principles and techniques of minimally invasive parathyroidectomy. 3) Learn how to improve the yield of preoperative imaging for primary hyperparathyroidism.