Nuances in parathyroid evaluation and management

Despite the many advancements that have occurred in the field of parathyroid surgery, the evaluation and management of a patient with primary hyperparathyroidism continues to pose a number of specific challenges to endocrine surgeons. The clinical experience of a single endocrine surgeon spanning more than a decade of parathyroid surgery was systematically assessed. Discrete challenges in the assessment and surgical management of patients with hyperparathyroidism were identified. Specific nuances and pearls and pitfalls were identified corresponding to the following 3 distinct aspects of the evaluation and management: diagnostic evaluation and confirmation of diagnosis; imaging and localization; and surgical principles. The evaluation and management of a patient with hyperparathyroidism is very often straightforward and nearly routine. However, up to 30% of the time important challenges occur at well-defined steps during the assessment and management pathway. Specific suggestions intended to improve the chances of a successful outcome are offered.