General Surgery

Answer 4 Identify all 4 glands, remove the enlarged gland, analyze the specimen intraoperatively using frozen section analysis, and measure PTH levels intraoperatively. In this patient, the presence of a single enlarged gland suggests an adenoma. All of the glands should be investigated to rule out hyperplasia or multiple adenomas; thus, only removing the enlarged gland without investigating the others is incorrect. Removing 3.5 glands and autotransplantation is the treatment for parathyroid hyperplasia, not for a parathyroid adenoma. In addition to identifying all of the glands and removing the enlarged gland, intraoperative frozen section analysis and measurement of PTH levels are necessary to confirm that levels are normalizing and the tissue is indeed an adenoma. SUGGESTED READINGS 1. Cameron JL, editor. Current surgical therapy. 8th ed. Philadelphia: Elsevier Mosby; 2004. 2. Townsend CM, Beauchamp RD, Evers BM, et al. Sabiston textbook of surgery: the biological basis of modern surgical practice. 17th ed. Philadelphia: Saunders; 2004. Click here to return to the questions

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