Hyperparathyroidism: evaluation of four decades of parathyroid surgery.

A review of 98 patients with hyperparathyroidism operated on at the University of Iowa during a 45-year period reveals a very great increase in the frequency of the clinical diagnosis. More patients are being operated on each year and more glands are being removed or biopsied. The proportion of patients in whom light microscopic examination of the parathyroid reveals hyperplasia remains less than 25%. Better methods are needed for identification of hyperplasia. Clinically, a few patients in whom the diagnosis of adenoma is made appear later to have more diffuse parathyroid disease. At present, however, when an adenoma is found, the decision to perform subtotal removal of apparently normal parathyroid tissue is made only reluctantly. The conclusion drawn from this review is that patients with hyperparathyroidism must be studied more intensively and followed for many years, whether or not an operation is performed. Although the diagnosis of hyperparathyroidism is now made readily and operative treatment seems to be more effective, much has yet to be learned about hyperparathyroidism.