[New aspects in the surgical treatment of hyperparathyroidism].

As a result of routine serum calcium determinations an increasing number of primary hyperparathyroidism (pHPT) cases are detected. While surgical treatment of the symptomatic patient with pHPT is generally accepted, this may not be the case in asymptomatic and especially elderly patients. The value of preoperative localization of parathyroid tumors has not been clearly established. In our experience dual parathyroid imaging with thallium and technetium has provided the best results. With the growing number of dialyzed patients, secondary (sHPT) and tertiary hyperparathyroidism (tHPT) are assuming increasing importance. Patients suffering from symptomatic sHPT or tHPT should undergo parathyroid surgery. After respective follow-up of 3.8 years (pHPT) and 2 years (sHPT and tHPT), all the cases with pHPT showed a relevant fall in serum calcium levels and PTH.