Multiple lesions of parathyroid glands in the primary hyperparathyroidism: key challenges

Multiple parathyroid gland (PTG) involvement in primary hyperparathyroidism (PHPT) is a complex clinical problem that requires a special approach. The identification and treatment of polyglandular lesions remains relevant despite modern medical advances. Objective. To systematize current data on methods of diagnosis, imaging, and surgical treatment of multiple parathyroid lesions, and to assess the prospects for prognostic algorithms. Materials and methods. A review of scientific papers over the past 20 years from the PubMed, Scopus, and Google Scholar databases was conducted using the key terms: “primary hyperparathyroidism,” “multiple parathyroid lesions,” “polyglandular pathology,” and “imaging methods.” Results. Multiple PTG lesions occur in 8–33% of sporadic PHPT cases. Traditional imaging methods (ultrasound, scanning) have limited effectiveness, whereas modern technologies (4D computed tomography, positron emission tomography with choline) significantly improve diagnosis. Prognostic models (CaPTHUS score, Wisconsin index) have been developed, but their clinical application requires further research. Bilateral surgical exploration of the neck is considered the optimal surgical approach for polyglandular lesions. Conclusion. Improved diagnostic methods and the introduction of personalized treatment approaches can improve outcomes in patients with multiple parathyroid lesions. The development and validation of complex predictive algorithms is a promising direction.