الفهرس 
Anatomy of Parathyroid GlandsOnly 14 pages are availabe for public view
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Abstract
Primary hyperparathyroidism (PHPT) is a common cause of hypercalcemia due to excessive secretion of parathormone (PTH). The pathophysiology of PHPT is related to the loss of the suppressive effect of extracellular Ca on PTH secretion. There are many causes of PHPT, and optimal therapy must be idividualized for each patient accordding to this etiology. Causes include: solitary adenoma (85%), multigland hyperplasia (10%), which may occur sporadically or in association with multiple endocrine neoplasia (MEN) type 1 or 2, double adenoma (3%) and carcinoma (2%).
Most commonly, patients present without symptoms, Hyperparathyroidism may be diagnosed in an otherwise asymptomatic patient by incidental discovery during routine blood chemistry analysis of calcium level. Symptoms of early disease, when present, are specific to hypercalcemia. They include muscle wheakness, depression, increased sleepiness, nausea, vomiting, acute abdominal pain (which might be the result of pancreatitis), constipation, and polydipsia. Frequent and occasionally painful urination and dysuria and/or back pain may be observed, the latter from nephrolithiasis.
Thus we recommend the routine use of ultrasound scan and technetium Tc 99m sestamibi scanning.
If the cause is solitary adenoma, treatment is by surgical removal of that gland.
If the cause is hyperplasia, there are two options for surgical treatment:
1- Subtotal parathyroidectomy i.e. removal of three glands with partial excision and presevationof well vascularized remnant of the fourth parathyroid gland in situ similar in size and weight to the normal gland.
2- Total parathyroidectomy with auto- transplantation in forearm musculature to avoid post operative presistent hypoparathyroidism.