A 35-year-old man is found to have MEN1 syndrome with primary hyperparathyroidism involving all four glands. The preferred surgical approach is:

• A Removal of the single largest gland only
• B Subtotal parathyroidectomy (3.5 glands) or total parathyroidectomy with autotransplantation ✓
• C Total parathyroidectomy with autotransplantation to the brachioradialis muscle
• D Cinacalcet therapy and deferred surgery

Explanation

In MEN1-associated primary hyperparathyroidism, all four glands are typically hyperfunctional. Both subtotal parathyroidectomy (leaving a 50 mg vascularised remnant) and total parathyroidectomy with forearm autotransplantation are acceptable and guideline-endorsed approaches. Total parathyroidectomy with autotransplantation facilitates easier re-operation if recurrence occurs (accessible forearm). Thymectomy is added to remove supernumerary glands.

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.