BACKGROUND: Subtotal parathyroidectomy (SPTX) is the treatment of choice for hyperparathyroidism in a patient with multiple endocrine neoplasia type 1 (HPT-MEN-1). There are scarce data on the causes, timing, and appropriate surgical treatment of patients with recurrent HPT-MEN-1. The aim of this study was to investigate the timing, causes, site of recurrence, and surgical treatment of recurrent HPT-MEN-1 in patients who underwent SPTX. METHODS: The study was a retrospective review of prospectively collected data on patients with HPT-MEN-1 with SPTX at two referral institutions. The data collected included the following: demographics, duration of follow-up, weight of resected parathyroid tissue, type of remnant, time to reoperation, cause/site of recurrence, and surgical treatment. We studied prognostic factors of recurrence. RESULTS: A total of 69 patients underwent SPTX and were followed for a mean of 75.3 months. After the surgery, 15 patients were left with a single "normal" gland and 54 with a 50- to 70-mg remnant of a partially excised abnormal gland. Nine patients (13%) had a recurrence within a mean of 85 months (12-144 months). Patients with a recurrence had been followed longer (115 vs. 66 months; p = 0.005). Five recurrences occurred in a parathyroid remnant, 3 in a previously "normal" gland; the fifth recurrence was in both a hyperplastic remnant and a fifth gland. Remedial surgery included five subtotal resections and four immediate parathyroid autotransplantations. Two patients had a second recurrence due to a supernumerary gland. Factors related with recurrence are the follow-up time (p < 0.01) and thymectomy (p < 0.003). CONCLUSIONS: Recurrence of HPTP-MEN-1 usually is located in preserved parathyroid tissue with no preference for a previously normal gland or a remnant. A second recurrence is most likely seen in a supernumerary gland. Recurrence is associated with the follow-up time and thymectomy.
BACKGROUND: Subtotal parathyroidectomy (SPTX) is the treatment of choice for hyperparathyroidism in a patient with multiple endocrine neoplasia type 1 (HPT-MEN-1). There are scarce data on the causes, timing, and appropriate surgical treatment of patients with recurrent HPT-MEN-1. The aim of this study was to investigate the timing, causes, site of recurrence, and surgical treatment of recurrent HPT-MEN-1 in patients who underwent SPTX. METHODS: The study was a retrospective review of prospectively collected data on patients with HPT-MEN-1 with SPTX at two referral institutions. The data collected included the following: demographics, duration of follow-up, weight of resected parathyroid tissue, type of remnant, time to reoperation, cause/site of recurrence, and surgical treatment. We studied prognostic factors of recurrence. RESULTS: A total of 69 patients underwent SPTX and were followed for a mean of 75.3 months. After the surgery, 15 patients were left with a single "normal" gland and 54 with a 50- to 70-mg remnant of a partially excised abnormal gland. Nine patients (13%) had a recurrence within a mean of 85 months (12-144 months). Patients with a recurrence had been followed longer (115 vs. 66 months; p = 0.005). Five recurrences occurred in a parathyroid remnant, 3 in a previously "normal" gland; the fifth recurrence was in both a hyperplastic remnant and a fifth gland. Remedial surgery included five subtotal resections and four immediate parathyroid autotransplantations. Two patients had a second recurrence due to a supernumerary gland. Factors related with recurrence are the follow-up time (p < 0.01) and thymectomy (p < 0.003). CONCLUSIONS: Recurrence of HPTP-MEN-1 usually is located in preserved parathyroid tissue with no preference for a previously normal gland or a remnant. A second recurrence is most likely seen in a supernumerary gland. Recurrence is associated with the follow-up time and thymectomy.
Authors: Dolores M Shoback; John P Bilezikian; Stewart A Turner; Laura C McCary; Matthew D Guo; Munro Peacock Journal: J Clin Endocrinol Metab Date: 2003-12 Impact factor: 5.958
Authors: C A Proye; A Goropoulos; C Franz; B Carnaille; M Vix; J L Quievreux; G Couplet-Lebon; A Racadot Journal: Surgery Date: 1991-12 Impact factor: 3.982
Authors: M L Brandi; R F Gagel; A Angeli; J P Bilezikian; P Beck-Peccoz; C Bordi; B Conte-Devolx; A Falchetti; R G Gheri; A Libroia; C J Lips; G Lombardi; M Mannelli; F Pacini; B A Ponder; F Raue; B Skogseid; G Tamburrano; R V Thakker; N W Thompson; P Tomassetti; F Tonelli; S A Wells; S J Marx Journal: J Clin Endocrinol Metab Date: 2001-12 Impact factor: 5.958
Authors: Laura A Lambert; Suzanne E Shapiro; Jeffrey E Lee; Nancy D Perrier; Mylene Truong; Michael J Wallace; Ana O Hoff; Robert F Gagel; Douglas B Evans Journal: Arch Surg Date: 2005-04
Authors: Maria A Kouvaraki; Jeffrey E Lee; Suzanne E Shapiro; Robert F Gagel; Steven I Sherman; Rena V Sellin; Gilbert J Cote; Douglas B Evans Journal: Arch Surg Date: 2002-06
Authors: D Bartsch; I Kopp; A Bergenfelz; H Rieder; K Münch; K Jäger; Y Deiss; A Schudy; P Barth; R Arnold; M Rothmund; B Simon Journal: Eur J Endocrinol Date: 1998-10 Impact factor: 6.664