Surgery for primary hyperparathyroidism 1962-1996: Indications and outcomes

Objective: To examine changes over the past three decades in the indications for, and outcomes of, surgery for primary hyperparathyroidism. Design: Survey of a prospective hospital database. Setting: Royal North Shore Hospital (a tertiary referral and university teaching hospital), Sydney, New South Wales, January 1962 to December 1996. Patients: All 733 patients who underwent neck exploration for primary hyperparathyroidism. Results: The annual number of parathyroidectomies increased virtually exponentially, from a mean of two in 1962-1969 to 73 in 1996. In the 1960s and 1970s, the most common indication for surgery was the presence of renal calculi (58% and 43%, respectively), but in the 1980s there was a marked increase in presentation of asymptomatic disease after biochemical screening (19%). In the 1990s, low bone mineral density detected by osteodensitometry has become the most common indication for surgery (31%). After initial operation, 11 patients (2%) had persistent hypercalcaemia, with five of these cured by reoperation - an overall failure rate of 1%. Conclusions: Surgery for primary hyperparathyroidism has become increasingly common, with low bone mineral density replacing renal calculi as the most common indication for surgery. Neck exploration in experienced hands results in an overall cure rate of 99%.