Plate 185
###### Figure 6

Hyperparathyroidism is a common endocrine disorder usually cured by subtotal parathyroidectomy. Parathyroid overactivity documented by appropriate laboratory studies may be associated with general hyperplasia of the parathyroid glands or with an adenoma involving one of the four or more parathyroid glands. Kidney stones, gastrinoma, recurrent pancreatitis, or other conditions are some of the clinical disorders that imply a disorder of the parathyroid glands. Hypercalcemia is discovered as a result of more frequent calcium determinations performed as part of a general screening survey. Hyperparathyroidism is associated with gastrinoma in approximately one-third of patients with the familial multiple endocrine syndrome I (MEN I). A mitogenic cause for the relatively high incidence of recurrent hyperparathyroidism in the familial MEN I syndrome suggests the need for a radical approach, which may consist of total parathyroidectomy with autotransplantation of parathyroid slices into the muscle in the nondominant forearm or removal of 3½ parathyroid glands.

Evidence of hyperparathyroidism associated with hypercalcemia of 12 mg per dL after renal transplantation may be an indication to consider a radical parathyroidectomy. Hypercalcemia and extremely high parathyroid hormone (PTH) values may occur after renal transplantation. This condition often resolves spontaneously, usually within a year of the transplantation. In general, a conservative observational approach should be taken within the first 2 years after renal transplantation, with operative intervention on the parathyroids only in patients who demonstrate progressive bone disease and who are clearly symptomatic.

Parathyroidectomy should precede surgical procedures for gastrinoma in patients with the MEN I syndrome. There is an apparent increase in supernumerary parathyroid glands in those with the familial MEN I syndrome, which suggests the need to remove the thymus, where an accessory parathyroid gland may be located when the cervical exploration is negative. More rarely, thyroidectomy may also be considered in a valiant search for a parathyroid gland buried within the thyroid gland if a parathyroid is not visible under the thyroid capsule.

The presence of one endocrine tumor suggests the desirability of a general search for other endocrine tumors, such as gastrinoma, pheochromocytoma, prolactinoma, and others, before parathyroidectomy is performed.

Recurrence of hyperparathyroidism after a parathyroidectomy requires a review of previous surgical procedures and a review of the pathologist's report on the parathyroids. Were the usual four glands found, and where were they? ...

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

## Subscription Options

### AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.