Parathyroid surgery in multiple endocrine neoplasia type 1

Primary hyperparathyroidism (PHPT) is the most common condition in patients with multiple endocrine neoplasia type 1 (MEN-1). Asymmetric, multi-gland disease due to multiple adenomas is characteristic in this cohort. The principal treatment of PHPT in MEN-1 patients is surgical. Options for surgical excision include subtotal (subPTX) or total parathyroidectomy with autotransplantation (totPTX). The optimal operation for these patients remains controversial. A 2011 systematic review and meta-analysis found no major difference in recurrence or persistence between subPTX and totPTX, but there were lower rates of hypocalcemia following subPTX. Recurrent PHPT in MEN-1 patients who have undergone initial parathyroidectomy is a challenging problem that should involve the input of experienced endocrine surgeons and endocrinologists. Alternative strategies such as alcohol ablation and cinacalcet administration may be warranted in some of these patients.