Parathyroid surgery for inherited endocrinopathies

Hyperparathyroidism presents as a component of selected familial endocrinopathies including multiple endocrine neoplasia types 1 and 2. These people develop multiple parathyroid adenomas that often present synchronously and can require operative intervention. The goals of the operation are to reduce the functional parathyroid mass to a point that normalizes the serum parathyroid hormone level, to avoid hypoparathyroidism, and to leave the residual parathyroid tissue in a place that can be safely accessed at the time of recurrent hyperparathyroidism. Recurrence is highly likely, as any residual parathyroid tissue has the propensity to develop subsequent adenomatous growth. The 2 main alternatives to accomplish these goals are to either remove all of the evident parathyroid tissue from the neck, and to move it to an accessible position, such as the forearm, as an autograft (total parathyroidectomy and autograft), or to remove nearly all of the parathyroid tissue from the neck, leaving a single focus of well-vascularized, carefully located tissue in the neck (subtotal parathyroidectomy).