In patients with MEN type 2A, hyperparathyroidism is a recognised concurrent condition that requires tailored surgical planning. The approach differs from sporadic hyperparathyroidism and depends on the pattern of parathyroid gland involvement at the time of surgery.
This protocol applies to patients with Multiple Endocrine Neoplasia Type 2A who have hyperparathyroidism. The number and extent of enlarged parathyroid glands are central to determining the appropriate surgical strategy.
Management is surgical, with the extent of intervention guided by how many parathyroid glands are visibly enlarged. The full decision algorithm — covering the different operative options based on glandular involvement — is set out in the structured protocol.
In patients with HPTH only visibly enlarged parathyroid glands should be resected.
If all four glands are enlarged surgical options include subtotal parathyroidectomy with a piece of one gland left in situ on a vascular pedicle or total parathyroidectomy with a heterotopic autograft.
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