Recent advances in the diagnosis and treatment of primary hyperparathyroidism

The incidence of hyperparathyroidism (pHPT) in Japan is lower than that in Western countries. The frequency of diagnosis, however, has increased due to the recent introduction of automated multichannel analysis of serum chemistry in routine screening and to the longevity of the Japanese population. The goal of surgical treatment for primary pHPT is restoration of calcium homeostasis by removal of hyperfunctioning parathyroid glands. Surgery is successful in over 95% of cases. The advent of the sestamibi scan in the early 1990s changed the management of pHPT. The trend has been toward less invasive procedures including endoscopic parathyroidectomy using sophisticated preoperative imaging tests, a hand-held gamma probe, and intraoperative rapid measurement of parathyroid hormone levels. We review recent advances in the diagnosis and treatment of pHPT.