Benign and/or malignant parathyroid tumors are involves a single parathyroid gland, while the other three glands are healthy. In parathyroid hyperplasia, the disease involve all four glands but parathyroid hyperplasia is not a tumor it is only increasing of the number of cells in the gland.
In the operation, surgeon must find the all four glands (which is a difficult task) and have to resect three of them.
Yes, chronic renal failure is the most common cause of parathyroid hyperplasia. Chronic renal failure cases often need to hemodyalysis. The time of hemodyalysis is related to risk of hyperplastic evolution of the parathyroid glands. The mechanism is not clear but calcium escape from the kidney to the urine is thought the main factor.
A 3-4cm long incision is made in front of the neck. The surgeon's work is more difficult than adenoma surgery. Because in adenoma surgery, it is enough to find only one parathyroid gland but in the hyperplasia surgery, surgeon must find all four glands. Moreover, since the glands are enlarged according to hyperplastic transformation, they moved to different places. In this situation the operation turns into looking for a needle in a haystack!
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Alo Yeditepe