Parathyroid hyperplasia can involve all parathyroid glands simultaneously and is encountered in 10-15% of cases of pHPT. This is more common in younger patients and/or in those with a known genetic/familial predisposition to disease. The surgical approach to this disease is somewhat different in that all parathyroid glands need to be visualised at operation in order to confirm the presence of disease. An experienced endocrine surgeon will then decide on how best to manage the problem based on the context but this will generally involve removal of more than one gland (ie. a subtotal parathyroidectomy). This type of disease is of more concern in younger patients and may necessitate genetic testing to clarify if there is an underlying disorder that predisposes to parathyroid gland disease.
