In sporadic primary hyperparathyroidism, the single most common cause of failed initial parathyroid surgery (persistent or recurrent hypercalcemia) is:

• A Parathyroid carcinoma not recognized intraoperatively
• B Ectopic adenoma in the mediastinum
• C Four-gland hyperplasia misidentified as single adenoma
• D Double adenoma missed at initial surgery ✓

Explanation

Double adenoma (two separate adenomas) accounts for approximately 2–5% of primary hyperparathyroidism but is the most common identifiable cause of failed surgery when a single adenoma was removed. The second adenoma, often in a different location, is missed at initial exploration. Ectopic mediastinal adenomas account for about 2–3% of failures and multigland disease accounts for another fraction. Intraoperative parathyroid hormone (iPTH) monitoring has reduced failure rates by identifying inadequate gland removal.

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.