PERSISTENT HYPERPARATHYROIDISM

PERSISTENT HYPERPARATHYROIDISM

Persistent hyperparathyroidism is defined as an elevated calcium within 6 weeks of surgical intervention. For all parathyroid operations (minimally invasive parathyroidectomy [MIP] and bilateral exploration) the rate of persistent hypercalcaemia is approximately 6% in sporadic disease and between 16% and 20% in hereditary disease. It usually arises as a result of a technical error during the first operation because of either a missed adenoma or asymmetrical disease. When this occurs all preoperative biochemistry , radiological imaging, intraoperative findings and pathology must be carefully reviewed. If reoperation is appropriate, repeat imaging of the neck and mediastinum is required (sestamibi, ultrasonography and 4D-CT scanning). Surgical intervention can be straightforward where there are intact tissue planes, such as following a minimally invasive parathyroidectomy . Complications, including recurrent laryngeal nerve damage and permanent hypocalcaemia, are increased when extensive previous dissection has occurred and the patient must be consented appropriately . PERSISTENT HYPERPARATHYROIDISM

Persistent hyperparathyroidism is defined as an elevated calcium within 6 weeks of surgical intervention. For all parathyroid operations (minimally invasive parathyroidectomy [MIP] and bilateral exploration) the rate of persistent hypercalcaemia is approximately 6% in sporadic disease and between 16% and 20% in hereditary disease. It usually arises as a result of a technical error during the first operation because of either a missed adenoma or asymmetrical disease. When this occurs all preoperative biochemistry , radiological imaging, intraoperative findings and pathology must be carefully reviewed. If reoperation is appropriate, repeat imaging of the neck and mediastinum is required (sestamibi, ultrasonography and 4D-CT scanning). Surgical intervention can be straightforward where there are intact tissue planes, such as following a minimally invasive parathyroidectomy . Complications, including recurrent laryngeal nerve damage and permanent hypocalcaemia, are increased when extensive previous dissection has occurred and the patient must be consented appropriately .