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Persistent and recurrent hyperparathyroidism

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Abstract

Despite remarkable progress in imaging modalities and surgical management, persistence or recurrence of primary hyperparathyroidism (PHPT) still occurs in 2.5–5% of cases of PHPT. The aim of this review is to expose the management of persistent and recurrent hyperparathyroidism. A literature search was performed on MEDLINE using the search terms “recurrent” or “persistent” and “hyperparathyroidism” within the past 10 years. We also searched the reference lists of articles identified by this search strategy and selected those we judged relevant. Before considering reoperation, the surgeon must confirm the diagnosis of PHPT. Then, the patient must be evaluated with new imaging modalities. A single adenoma is found in 68% of cases, multiglandular disease in 28%, and parathyroid carcinoma in 3%. Others causes (<1%) include parathyromatosis and graft recurrence. The surgeon must balance the benefits against the risks of a reoperation (permanent hypocalcemia and recurrent laryngeal nerve palsy). If surgery is necessary, a focused approach can be considered in cases of significant imaging foci, but in the case of multiglandular disease, a bilateral neck exploration could be necessary. Patients with multiple endocrine neoplasia syndromes are at high risk of recurrence and should be managed regarding their hereditary pathology. The cure rate of persistent-PHPT or recurrent-PHPT in expert centers is estimated from 93 to 97%. After confirming the diagnosis of PHPT, patients with persistent-PHPT and recurrent-PHPT should be managed in an expert center with all dedicated competencies.

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Authors and Affiliations

  1. Department of Endocrine Surgery, La Conception Hospital, Assistance Publique Hopitaux de Marseille, 147 BD Baille, 13005, Marseille, France

    Carole Guerin, Nunzia Cinzia Paladino & Fréderic Sebag

  2. Aix-Marseille University, Medical School, 27, bd Jean Moulin, 13385, Marseille Cedex 05, France

    Carole Guerin, Fréderic Castinetti, David Taieb & Fréderic Sebag

  3. Department of Surgery, University Hospital Limerick and Graduate Entry Medical School University of Limerick, Limerick, Ireland

    Aoife Lowery

  4. Department of Endocrinology, La Conception Hospital, Assistance Publique Hopitaux de Marseille, 147 BD Baille, 13005, Marseille, France

    Fréderic Castinetti

  5. Department of Nuclear Medicine, La Timone Hospital, Assistance Publique Hopitaux de Marseille, 264 Rue Saint-Pierre, 13385, Marseille, France

    David Taieb

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  1. Carole Guerin
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  2. Nunzia Cinzia Paladino
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Correspondence to Carole Guerin.

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Guerin, C., Paladino, N.C., Lowery, A. et al. Persistent and recurrent hyperparathyroidism. Updates Surg 69, 161–169 (2017). https://doi.org/10.1007/s13304-017-0447-7

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