BACKGROUND: To evaluate the outcomes in different surgical modalities for primary hyperparathyroidism in multiple endocrine neoplasia type 1 (MEN1) patients, intraoperative findings from a single surgeon were studied to investigate a potentially improved modality of parathyroidectomy (PTx). METHODS: All 22 patients had PTx by a single surgeon in the past 21 years. Three modalities of PTx were used, depending on the operative findings, after all parathyroids and the thymus were identified. If fewer than three glands were enlarged, selective removal of the enlarged glands with or without biopsy of a normal-appearing gland was performed (selective PTx); if all glands were enlarged, either a subtotal PTx leaving a 50-mg remnant in situ or a total PTx with autotransplantation (TPTx + AT) was performed. RESULTS: There were 7 men and 15 women, aged 22 to 67 years (average, 43 years). Sixteen had familial and six had sporadic MEN1. They underwent 23 operations, including 11 selective PTx, 6 subtotal PTx, and 6 TPTx + AT. On follow-up for 1 to 19 years, only one patient (4.6%) had recurrent hyperparathyroidism 5.5 years after subtotal PTx. Others had either normocalcemia (n = 14; 63.6%) or hypocalcemia (n = 7; 31.8%). Those who had either a subtotal PTx or TPTx + AT had a significantly higher rate of postoperative hypocalcemia than those who had a selective PTx (9.9% vs. 54.5%; P = .032; Fisher's exact test). CONCLUSIONS: Primary hyperparathyroidism in our MEN1 patients was less aggressive than that reported in the literature. Selective PTx according to the intraoperative findings achieved optimal outcomes.
BACKGROUND: To evaluate the outcomes in different surgical modalities for primary hyperparathyroidism in multiple endocrine neoplasia type 1 (MEN1) patients, intraoperative findings from a single surgeon were studied to investigate a potentially improved modality of parathyroidectomy (PTx). METHODS: All 22 patients had PTx by a single surgeon in the past 21 years. Three modalities of PTx were used, depending on the operative findings, after all parathyroids and the thymus were identified. If fewer than three glands were enlarged, selective removal of the enlarged glands with or without biopsy of a normal-appearing gland was performed (selective PTx); if all glands were enlarged, either a subtotal PTx leaving a 50-mg remnant in situ or a total PTx with autotransplantation (TPTx + AT) was performed. RESULTS: There were 7 men and 15 women, aged 22 to 67 years (average, 43 years). Sixteen had familial and six had sporadic MEN1. They underwent 23 operations, including 11 selective PTx, 6 subtotal PTx, and 6 TPTx + AT. On follow-up for 1 to 19 years, only one patient (4.6%) had recurrent hyperparathyroidism 5.5 years after subtotal PTx. Others had either normocalcemia (n = 14; 63.6%) or hypocalcemia (n = 7; 31.8%). Those who had either a subtotal PTx or TPTx + AT had a significantly higher rate of postoperative hypocalcemia than those who had a selective PTx (9.9% vs. 54.5%; P = .032; Fisher's exact test). CONCLUSIONS:Primary hyperparathyroidism in our MEN1patients was less aggressive than that reported in the literature. Selective PTx according to the intraoperative findings achieved optimal outcomes.
Authors: Maria D Balsalobre Salmeron; Jose Manuel Rodriguez Gonzalez; Joan Sancho Insenser; Joan Sancho Fornos; Albert Goday; Nuria Maria Torregrosa Perez; Antonio Rios Zambudio; Pascual Parrilla Paricio; Antonio Sitges Serra Journal: World J Surg Date: 2010-06 Impact factor: 3.352
Authors: Jennifer M J Schreinemakers; Carolina R C Pieterman; Anouk Scholten; Menno R Vriens; Gerlof D Valk; Inne H M Borel Rinkes Journal: World J Surg Date: 2011-09 Impact factor: 3.352
Authors: Jeffrey A Norton; David J Venzon; Marc J Berna; H R Alexander; Douglas L Fraker; Stephen K Libutti; Stephen J Marx; Fathia Gibril; Robert T Jensen Journal: Ann Surg Date: 2008-03 Impact factor: 12.969
Authors: Bas A Twigt; Anouk Scholten; Gerlof D Valk; Inne H M Borel Rinkes; Menno R Vriens Journal: Orphanet J Rare Dis Date: 2013-04-01 Impact factor: 4.123