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Surgical Pathology of the Parathyroid Glands
Development and Anatomy The parathyroid glands develop from the endoderm of pharyngeal pouches III and IV. These are first identifiable at 5 to 6 weeks of fetal development as thickenings of the anterodorsal branchial pouch epithelium (see Chapter 2 ,…
Parathyroid Carcinoma
Video 64.1 Parathyroid Carcinoma: Management Principles with an Illustrative Case Background Parathyroid carcinoma (PC) is a rare but ominous cause of primary hyperparathyroidism (HPT). It accounts for less than 1% of the cases of primary HPT. In a retrospective study…
Revision Parathyroid Surgery
Introduction As many as 10% of patients who had previous operations for primary hyperparathyroidism (PHPT) will experience persistent or recurrent disease after surgery ( Box 63.1 ). Due to the sequelae of PHPT, some of these patients will require reoperative…
Parathyroid Management in the MEN Syndromes
Primary hyperparathyroidism (PHPT) is the presence of elevated serum calcium levels combined with inappropriate suppression of parathyroid hormone (PTH). It is most commonly a sporadic disease; however, in a small subset of patients, it can be part of a familial…
Surgical Management of Secondary and Tertiary Hyperparathyroidism
Video 61.1 Total Parathyroidectomy with Forearm Autograft for Patients with Advanced Secondary Hyperparathyroidism. Video 61.2 Total Parathyroidectomy with Forearm Autograft for Patients with Advanced Secondary Hyperparathyroidism: Usefulness of IONM. Secondary Hyperparathyroidism Definition Secondary hyperparathyroidism (SHPT) refers to the situation in…
Surgical Management of Multiglandular Parathyroid Disease
Albright’s 1934 description of primary water clear cell hyperplasia, that involving all four parathyroids represents the first recognition of the concept of primary hyperparathyroidism (PHPT) due to multiple gland disease (MGD) rather than single-gland disease. Although the incidence of this…
Intraoperative PTH Monitoring During Parathyroid Surgery
Introduction Intraoperative parathyroid hormone monitoring (IPM) has been used since the 1990s to guide the excision of abnormal parathyroid glands in patients with sporadic primary hyperparathyroidism (SPHPT). Currently, many high-volume parathyroid surgeons use IPM, selectively or routinely, to guide parathyroidectomy…
Minimally Invasive Video-Assisted Parathyroidectomy
Introduction Bilateral neck exploration (BNE) with the identification of at least four parathyroid glands and the removal of pathologic parathyroid tissue has represented, for several decades, the standard of treatment of primary hyperparathyroidism (PHPT) (see Chapter 56 , Standard Bilateral…
Minimally Invasive Single Gland Parathyroid Exploration
Video 57.1 Minimally Invasive Parathyroidectomy. Background Subsequent to the first parathyroidectomy documented in the literature (in 1925 by Felix Mandl of Vienna), four-gland exploration via a generous incision was the standard technique until the 1970s and 1980s. The advent of…