BACKGROUND: Historically, multigland hyperplasia was believed to be the predominant cause of primary hyperparathyroidism (PHPT) in young patients, and hence a relative contraindication for minimally invasive parathyroidectomy. Recent studies, however, demonstrate that the most common aetiology across all age groups is a solitary functioning adenoma. The aim of this study was to compare long-term outcomes in young patients (≤ 45 years), especially those under 30 years of age, with their older counterparts (> 45 years) following focused minimally invasive parathyroidectomy (FMIP). MATERIALS AND METHODS: Patients ≤ 45 years who underwent FMIP between January 1999 and December 2007 were identified from an endocrine surgery database and compared with a matched control group of patients > 45 years old also undergoing FMIP within that time period. The patients' most recent calcium levels (≥ 6 months postoperatively) were examined to establish recurrence rates. Recurrence was defined as an elevation of serum calcium more than 6 months after surgery following initial postsurgical normocalcemia. RESULTS: A total of 117 patients ≤ 45 years and 160 patients > 45 years who underwent FMIP were examined. Follow-up calcium levels were available for 72% of patients. The median length of follow-up was 46 months. No recurrences were identified in both the younger and older cohort of patients; therefore, no statistically significant difference in rates of recurrence could be determined between age groups. CONCLUSION: Recurrence of PHPT following FMIP is rare with no evidence of a higher incidence in younger patients. FMIP can be safely offered to young patients as a long-term durable treatment option.
BACKGROUND: Historically, multigland hyperplasia was believed to be the predominant cause of primary hyperparathyroidism (PHPT) in young patients, and hence a relative contraindication for minimally invasive parathyroidectomy. Recent studies, however, demonstrate that the most common aetiology across all age groups is a solitary functioning adenoma. The aim of this study was to compare long-term outcomes in young patients (≤ 45 years), especially those under 30 years of age, with their older counterparts (> 45 years) following focused minimally invasive parathyroidectomy (FMIP). MATERIALS AND METHODS:Patients ≤ 45 years who underwent FMIP between January 1999 and December 2007 were identified from an endocrine surgery database and compared with a matched control group of patients > 45 years old also undergoing FMIP within that time period. The patients' most recent calcium levels (≥ 6 months postoperatively) were examined to establish recurrence rates. Recurrence was defined as an elevation of serum calcium more than 6 months after surgery following initial postsurgical normocalcemia. RESULTS: A total of 117 patients ≤ 45 years and 160 patients > 45 years who underwent FMIP were examined. Follow-up calcium levels were available for 72% of patients. The median length of follow-up was 46 months. No recurrences were identified in both the younger and older cohort of patients; therefore, no statistically significant difference in rates of recurrence could be determined between age groups. CONCLUSION: Recurrence of PHPT following FMIP is rare with no evidence of a higher incidence in younger patients. FMIP can be safely offered to young patients as a long-term durable treatment option.
Authors: Lee F Starker; Tobias Akerström; William D Long; Alberto Delgado-Verdugo; Patricia Donovan; Robert Udelsman; Richard P Lifton; Tobias Carling Journal: Horm Cancer Date: 2012-04 Impact factor: 3.869