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Multiglandular Parathyroid Disease and MEN Syndromes

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Surgery of the Thyroid and Parathyroid Glands

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24.9 Summary

Parathyroid surgery in the setting of familial disorders resulting in multiglandular disease is challenging for the endocrine surgeon. The aim of surgery is to gain eucalcemia for a long time without producing hypocalcemia. Since the syndromes are rare, sufficient data are lacking in most diseases. MEN1-HPTH should be treated with subtotal or total PTX with autotransplantation. Surgery in MEN2A has to be more tailored to the individual patient and subtotal PTX, total PTX and autotransplantation as well as excision of grossly enlarged glands might be alternatives depending on the patient’s history of the disease. The surgical approach to patients with HPTH-JTS is the same as to MEN2A-HPTH. Nevertheless radical surgery may be required in this special setting, since the incidence of parathyroid carcinoma is comparably high in these patients.

Cryopreservation of parathyroid tissue is mandatory in all cases of familial HPTH. The role of minimally invasive parathyroid surgery in familial HPTH is limited and should only be performed in redo cases combined with intraoperative PTH measurements.

Patients with FHH do not benefit from parathyroid surgery whereas infants with neonatal severe HPTH need to be operated on and total parathyroidectomy performed.

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Authors and Affiliations

  1. Department of Surgery, Philipps-University Hospital, Baldingerstrasse, D-35043, Marburg, Germany

    Peter Langer

  2. Department of Surgery, Philipps-University, Marburg, Germany

    Detlef K. Bartsch & Matthias Rothmund

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Editors and Affiliations

  1. Division of General Surgery, University Hospital Basel, 4031, Basel, Switzerland

    Daniel Oertli (Vice-Dean of the Medical Faculty) (Vice-Dean of the Medical Faculty)

  2. University of Basel, 4031, Basel, Switzerland

    Daniel Oertli (Vice-Dean of the Medical Faculty) (Vice-Dean of the Medical Faculty)

  3. Yale University School of Medicine, PO Box 208062, New Haven, CT, 06520-8062, USA

    Robert Udelsman (Lampman Professor of Surgery and Oncology, Chairman, Department of Surgery, Surgeon-in-Chief-Yale-New Haven Hospital) (Lampman Professor of Surgery and Oncology, Chairman, Department of Surgery, Surgeon-in-Chief-Yale-New Haven Hospital)

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Langer, P., Bartsch, D.K., Rothmund, M. (2007). Multiglandular Parathyroid Disease and MEN Syndromes. In: Oertli, D., Udelsman, R. (eds) Surgery of the Thyroid and Parathyroid Glands. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-68043-7_24

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  • DOI: https://doi.org/10.1007/978-3-540-68043-7_24

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