ABSTRACT
This retrospective article reports the diagnostic experiences of forty six cases of hyperparathyroidism confirmed by operation and pathologic examination. From 1976 to 2002, all the patients who had conventional neck exploration for hyperparathyroidism were investigated. Eleven surgeons performed the operations by doing only 1 up to 18 procedures. Experience of surgeon and the result of frozen section were determined adequacy of procedure and completeness of operation. The clinical presentation was divided into four types: 24 cases [52.17%] with bone resorption; 15 cases [32.60%] with bone lesions plus urinary calculus; 4 cases [8.69%] with urinary calculus and 3 cases [6.52%] with asymptomatic hypercalcemia. The mean age of 46 patients [35 women, 11 men] was 44 [range 1 month to 67] years. Mean preoperative serum calcium was 13 [range 10.5 to 30] mg/ 100ml. Two patients in one family had neonatal primary hyperparathyroidism. One patient had chronic renal failure. Neck sonography was done in 18 and parathyroid [Sestamibi] scan was done in 3 with accuracy of 66.66% and 100% subsequently. The pathological diagnosis was parathyroid adenoma in 37, hyperplasia in 5, parathyroid carcinoma in 1 and negative exploration in 3. The clinical picture of PHPT in south of Iran is similar to that recognized previously in west. We are expecting routine measurement of serum calcium and high suspicioun by the physician in patients with symptoms of musculoskeletal system or renal stone can lead to early diagnosis. By using parathyroid scan and sonography of neck localization of most parathyroid adenoma is possible. Therefore minimal access adenomectomy can be replaced by conventional neck exploration