A 58-year-old man with MEN1 syndrome has biochemically proven primary hyperparathyroidism with four-gland disease confirmed on sestamibi scan. He has had two previous neck operations. The preferred surgical approach for this scenario is:
- A Four-gland exploration with subtotal parathyroidectomy or total parathyroidectomy with autotransplantation ✓
- B Unilateral parathyroid exploration guided by sestamibi
- C Medical management with cinacalcet only
- D Minimally invasive parathyroidectomy via video-assisted approach
Correct answer: A. Four-gland exploration with subtotal parathyroidectomy or total parathyroidectomy with autotransplantation
Explanation
MEN1-associated hyperparathyroidism invariably involves multiglandular disease; the recommended operation is either subtotal parathyroidectomy (3.5 glands removed) or total parathyroidectomy with forearm autotransplantation to allow future non-neck reoperation if recurrence occurs. Focused unilateral exploration is contraindicated because of near-universal multiglandular involvement in MEN1.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.