The Fellowship of the European Board of Surgery in Endocrine Surgery (UEMS/ESES) covers thyroid, parathyroid, adrenal and neuroendocrine disease. Practise with FEBS Endocrine questions on thyroid cancer risk stratification, parathyroid localisation, adrenal surgery and MEN syndromes, each referenced to ATA, ESES and ESMO guidance.
Content reviewed 26 August 2026 against current guidelines.
Start practising freeTaken from the bank, not written for this page. Answer it in your head, then open the explanation.
A 38-year-old man with a history of kidney stones and recurrent peptic ulcers presents for evaluation. Serum calcium is 3.0 mmol/L, PTH 110 pg/mL (elevated), gastrin 1200 pg/mL (elevated). MRI shows a 1.5cm pancreatic lesion. He has a family history of pituitary adenoma in his father and a parathyroid adenoma in his paternal uncle. Genetic testing returns a heterozygous pathogenic MEN1 gene mutation. What is the recommended approach to the parathyroid disease component in this MEN1 patient?
Correct answer: E
MEN1-associated primary hyperparathyroidism (PHPT) is almost universally multiglandular — all four parathyroid glands are affected by hyperplasia or multiple adenomas, though not necessarily equally enlarged at the same time. This is a critical distinction from sporadic PHPT where a single adenoma is found in 80-85% of cases. Surgical management for MEN1-associated PHPT: (1) Subtotal parathyroidectomy (3.5-gland resection — leaving approximately half of the most normal-appearing gland in situ, typically marked with a clip or suture) is the most commonly performed procedure with recurrence rates of 20-30% at 10-15 years. (2) Total parathyroidectomy with forearm autotransplantation — removes all four glands and reimplants minced parathyroid tissue into the brachioradialis muscle of the non-dominant arm. Allows easier re-operation if needed (forearm excision under local anaesthesia). Permanent hypoparathyroidism in approximately 10-15% of cases. Both approaches are endorsed by ENETS 2023 and Endocrine Society MEN1 guidelines. Focused parathyroidectomy (removing only the largest gland) has recurrence rates exceeding 70% in MEN1 due to multiglandular disease — it is generally contraindicated in MEN1 PHPT. All four glands must be identified at surgery. Normal-appearing glands should not be left in situ without proper assessment — all glands are affected in MEN1.
Teaching point. MEN1 PHPT is always multiglandular. Standard surgery: subtotal (3.5-gland) parathyroidectomy OR total parathyroidectomy + forearm autotransplantation. Focused parathyroidectomy is contraindicated — recurrence rate >70%.
Referenced to ENETS 2023 MEN1 Guidelines; Endocrine Society MEN1 Clinical Practice Guideline (Thakker et al., J Clin Endocrinol Metab 2012)
Every question is explained like this — start with 50 free ›Every question is written by Pablo Lozano Lominchar, MD, PhD, and mapped to this board’s published syllabus. Before it enters the bank it has to pass an automated check: five options, a written explanation, and a citation — a named society guideline or a named trial. Benign and functional topics cannot be published without a society guideline; oncological ones cite NCCN, ESMO or AJCC, and the classification systems that govern a topic — Bethesda, TIRADS, Atlanta, Prague, Chicago — have to appear where they apply. The author has audited the full active bank against current guideline versions: what fails is re-cited, rewritten or withdrawn. 650 questions are currently withdrawn and are served to nobody.
Scope of authorship. FEBS Endocrine sits outside the author’s own subspecialty practice, which is surgical oncology — peritoneal malignancy, sarcoma, hepatopancreatobiliary and complex pelvic surgery. No diplomate of this board has signed these questions off. What they offer is traceability rather than personal authority: every answer names the current guideline or trial it rests on, so you can check it at the source before you trust it. Found an error? Tell us — it gets corrected or withdrawn.
Master ATA risk stratification and the extent-of-surgery debate in thyroid cancer, pheochromocytoma preoperative preparation, and the RET codon-to-phenotype correlations in MEN2. Practise timed questions and rehearse MEN1/MEN2 scenarios for the oral component.
SurgBoardsQ&A provides more than 1,900 endocrine surgery practice questions mapped to the FEBS Endocrine syllabus, each with a detailed, guideline-referenced explanation.
The exam covers thyroid cancer, parathyroid disease and hyperparathyroidism, adrenal surgery including pheochromocytoma, and pancreatic neuroendocrine tumours with the MEN syndromes.
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