Trends in primary hyperparathyroidism surgery.

Controversy exists concerning indications for primary hyperparathyroidism surgery, tests to localize parathyroid tumors, pathologic criteria for adenoma and hyperplasia, and unilateral versus bilateral surgery for hyperparathyroidism. Seventy cases were reviewed. Results of localization tests, sites of aberrant tumors, symptoms, complications, and ratio of adenoma to hyperplasia will be presented. The foreseeable trends are continued improvement in localization techniques, earlier intervention in the disease spectrum, unilateral exploration for adenoma and bilateral surgery for hyperplasia, and acceptance of primary nodular hyperplasia and normal size with hypercellularity as pathologic entities in primary parathyroid hyperplasia.