A 41-year-old man with MEN1 presents for evaluation of primary hyperparathyroidism. Vital signs are normal (BP 128/82, HR 72, RR 14, Temp 37°C). Laboratory studies show ionized calcium 5.8 mg/dL, PTH 156 pg/mL, and phosphate 2.3 mg/dL. Serum creatinine is 0.9 mg/dL. Dual-energy x-ray absorptiometry shows normal bone mineral density. He denies nephrolithiasis, cognitive changes, or polyuria. Which of the following is the most appropriate management recommendation?
- A)Observation with serial monitoring of serum calcium and PTH annually
- B)Single parathyroid adenoma removal after preoperative localization
- C)Medical management with cinacalcet as long-term definitive therapy
- D)Vitamin D and calcium supplementation to prevent osteoporosis
- E)Bilateral subtotal parathyroidectomy or total parathyroidectomy with autotransplantation due to high recurrence risk in MEN1GABARITO
Explicação
In MEN1 (inactivated MENIN tumor suppressor gene), hyperparathyroidism is caused by parathyroid hyperplasia rather than a single adenoma. Recurrence rates after conservative surgery are very high (>80%). Bilateral subtotal parathyroidectomy or total parathyroi... Ver explicação completa e trilha adaptativa →