Primary hyperparathyroidism. Pathogenesis--diagnosis--therapy]

A report is given on 33 patients with primary hyperparathyroidism who underwent surgical treatment in our institution in the period from 1980 to 1989. In 57 per cent of the cases a hypercalcaemic syndrome was present. The primary hyperparathyroidism manifested itself in 75 per cent at the kidneys in the form of nephrolithiasis. One third of the patients showed a renal manifestation form exclusively. Remarkable is the relatively high number of exclusively gastrointestinal manifestations (11 per cent). In all patients the diagnosis was established on the coincidence of hypercalcaemia and increased parathormone in the serum. Preoperative localization diagnostics by means of parathyroid sonography, computed tomography and scintigraphy yielded unsatisfactory results. A satisfactory accuracy with regard to the lateral localization of the hyperfunctioning parathyroid tissue can presently be achieved only by selective catheterization of the cervical vein with determination of the parathormone. 35 patients clinically suspected of having primary hyperparathyroidism were subjected to a total of 44 operative interventions, i.e., apart from 35 primary operations, 7 secondary and 2 tertiary interventions. Of the 35 primary operations, 10 (28.6 per cent) were without success. This was due to 2 misdiagnoses and 8 cases with insufficient intraoperative exploration and premature discontinuation of the operation. In 67 per cent of the cases, there was a predominance of the solitary parathyroid adenoma, which was chiefly located at the dorsal lower thyroid poles. In order to reduce the number of unsuccessful primary interventions, a surgically-tactical approach is recommended.