Ján Podoba, Ivan Brychta
Parathyroidectomy has been recognized as the only definitive therapy for primary hyperparathyroidism, i.e. surgical removal of adenoma (adenomas) or subtotal parathyroid resection for hyperplasia. Surgery is indicated in a symptomatic disease with organ complications. In the case of an asymptomatic disease clear criteria for surgery have been developed. The effect of surgery is improved by several preoperative imaging techniques and introduction of peroperative assessment of parathyroid hormone concentration, which enabled miniinvasive surgical procedures. In patients who are going to be managed without surgery for contraindications or high operative risks, specific medical therapy targeting hypercalcemia and/or osteoporosis may be of value. However, there are still patients with asymptomatic primary hyperparathyroidism for whom a nontherapeutical approach with follow-up is safe at least over the first 8 years.