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Objective: To study the appropriateness of minimally invasive surgical treatment of primary hyperparathyroidism., Design: Prospective., Setting: University Hospital Utrecht, the Netherlands., Method: In patients with primary hyperparathyroidism, parathyroid adenomas were located preoperatively by means of Doppler assisted ultrasonography and spiral computer tomography. If the results were positive, minimally invasive surgery was performed., Results: Minimally invasive surgery was carried out in 13 out of 15 successive patients with good results (the serum calcium and parathyroid hormone levels returned to normal). Two patients were subjected to conventional neck exploration, also with good results (preoperatively several adenomas were suspected in one, while no adenoma was seen in the other)., Conclusion: It can be calculated that minimally invasive surgery will probably suffice in 60-70% of the patients with primary hyperparathyroidism, so that conventional neck exploration can be avoided.

Pseudohypoparathyroidism is a condition in which for some reason the normal effect of PTH in the target organ fails to occur. In the Ia type here described the signal transmission is impaired due to abnormal genetic development of the stimulating G protein (Gs) in the cell membrane resulting in insufficient cAMP production after binding of PTH on the membrane receptor. The failure to occur of the normal PTH effect impairs the calcium homeostasis. In many cases this type of pseudohypoparathyroidism is associated with phenotypical characteristics such as short stature, round face, obesity, brachydactyly, subcutaneous and intracerebral calcifications and sometimes bradyphrenia. Since the Gs protein aspecifically also brings about production of cAMP after binding of other polypeptide hormones to this hormone-specific receptor, several hormone resistances may be present concurrently.