Primary Hyperparathyroidism

Answer: a, b, c, d, e



All of the indications listed above are considered indications for operative treatment of asymptomatic patients with primary hyperparathyroidism. Their conclusions regarding operative indications are summarized in Table 57-8. The NIH Consensus Development Conference mandated close (every 6 months) follow-up for patients with known primary hyperparathyroidism not treated by operation. In addition, surgery was agreed upon for those patients in whom medical surveillance was neither desirable nor suitable, such as when the patient requests surgery, consistent follow-up is unlikely, co-existent illness complicates management, or if the patient is young.
In one recent study of a group of 142 asymptomatic patients followed without operation, after 10 years, more than 20% of the patients had required surgery for an increase in serum calcium to greater than 11 mg/dL or for specific complications attributable to the disease. Another 20% were lost to or declined follow-up. The remainder either died of unrelated causes or had persistent asymptomatic disease. This remains an area of considerable controversy. The best available recommendations are derived from this October 1990 NIH Consensus Development Conference.

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