2 Indications and current treatments
2.1 Hyperparathyroidism typically leads to hypercalcaemia. Symptoms include tiredness, depression, confusion, constipation, polydipsia, polyuria, the development of kidney stones, bone pain and fractures. The most common cause of primary hyperparathyroidism is a single adenoma. Other causes include hyperplasia affecting more than 1 parathyroid gland and, rarely, cancer. Secondary hyperparathyroidism can also occur, resulting from conditions such as kidney disease, vitamin D deficiency and gut malabsorption.
2.2 Patients with mild hyperparathyroidism may not need active treatment, but are regularly monitored. More severe hyperparathyroidism is usually treated by surgery to remove the abnormal parathyroid gland or glands.
2.3 Conventional open parathyroidectomy is done through a transverse neck incision, typically 3–6 cm long, and open minimally invasive (focused) parathyroidectomy typically needs a smaller incision of 2–3 cm. Endoscopic techniques have been developed that use smaller incisions, with the aims of reducing pain after surgery and improving cosmesis.