Unilateral Clearance for Primary Hyperparathyroidism in Selected Patients with Multiple Endocrine Neoplasia Type 1
Background Primary hyperparathyroidism is the most common manifestation of multiple endocrine neoplasia type 1 (MEN1). Guidelines advocate subtotal parathyroidectomy (STP) or total parathyroidectomy with autotransplantation due to high prevalence of multiglandular disease; however, both are associat...
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| Autor*in: |
Kluijfhout, Wouter P. [verfasserIn] |
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| Format: |
E-Artikel |
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| Sprache: |
Englisch |
| Erschienen: |
2016 |
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| Schlagwörter: |
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| Anmerkung: |
© The Author(s) 2016 |
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| Übergeordnetes Werk: |
Enthalten in: World Journal of Surgery - Springer-Verlag, 1996, 40(2016), 12 vom: 11. Juli, Seite 2964-2969 |
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| Übergeordnetes Werk: |
volume:40 ; year:2016 ; number:12 ; day:11 ; month:07 ; pages:2964-2969 |
| Links: |
|---|
| DOI / URN: |
10.1007/s00268-016-3624-9 |
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| Katalog-ID: |
SPR003455297 |
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| 520 | |a Background Primary hyperparathyroidism is the most common manifestation of multiple endocrine neoplasia type 1 (MEN1). Guidelines advocate subtotal parathyroidectomy (STP) or total parathyroidectomy with autotransplantation due to high prevalence of multiglandular disease; however, both are associated with a significant risk of permanent hypoparathyroidism. More accurate imaging and use of intraoperative PTH levels may allow a less extensive initial parathyroidectomy (unilateral clearance, removing both parathyroids with cervical thymectomy) in selected MEN1 patients with primary hyperparathyroidism. Methods We performed a retrospective cohort study at a high-volume tertiary medical center including patients with MEN1 and primary hyperparathyroidism, who underwent STP or unilateral clearance as their initial surgery from 1995 to 2015. Unilateral clearance was offered to patients who had concordant sestamibi and ultrasound showing a single enlarged parathyroid gland. For both the groups, we compared rates of persistent/recurrent disease and permanent hypoparathyroidism. Results Eight patients had unilateral clearance and 16 had STP. Subtotal parathyroidectomy patients were younger (37 vs 52 years). One patient in each group had persistent disease. One (13 %) unilateral clearance and five (31 %) STP patients had recurrent hyperparathyroidism after a mean follow-up of 47 and 68 months (p = 0.62). No unilateral clearance patients and two of 16 SPT patients had permanent hypoparathyroidism (p = 0.54). Conclusions Some MEN1 patients with primary hyperparathyroidism who have concordant localizing studies may be selected for unilateral clearance as an alternative to STP. For appropriately selected MEN1 patients, unilateral clearance can achieve similar results as STP and has no risk of permanent hypoparathyroidism, and may facilitate possible future reoperations. | ||
| 650 | 4 | |a Parathyroid Gland |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Primary Hyperparathyroidism |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Cinacalcet |7 (dpeaa)DE-He213 | |
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| 700 | 1 | |a Drake, Frederick Thurston |4 aut | |
| 700 | 1 | |a Vriens, Menno R. |4 aut | |
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| 700 | 1 | |a Shen, Wen T. |4 aut | |
| 700 | 1 | |a Suh, Insoo |4 aut | |
| 700 | 1 | |a Liu, Chienying |4 aut | |
| 700 | 1 | |a Duh, Quan-Yang |4 aut | |
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10.1007/s00268-016-3624-9 doi (DE-627)SPR003455297 (SPR)s00268-016-3624-9-e DE-627 ger DE-627 rakwb eng Kluijfhout, Wouter P. verfasserin aut Unilateral Clearance for Primary Hyperparathyroidism in Selected Patients with Multiple Endocrine Neoplasia Type 1 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2016 Background Primary hyperparathyroidism is the most common manifestation of multiple endocrine neoplasia type 1 (MEN1). Guidelines advocate subtotal parathyroidectomy (STP) or total parathyroidectomy with autotransplantation due to high prevalence of multiglandular disease; however, both are associated with a significant risk of permanent hypoparathyroidism. More accurate imaging and use of intraoperative PTH levels may allow a less extensive initial parathyroidectomy (unilateral clearance, removing both parathyroids with cervical thymectomy) in selected MEN1 patients with primary hyperparathyroidism. Methods We performed a retrospective cohort study at a high-volume tertiary medical center including patients with MEN1 and primary hyperparathyroidism, who underwent STP or unilateral clearance as their initial surgery from 1995 to 2015. Unilateral clearance was offered to patients who had concordant sestamibi and ultrasound showing a single enlarged parathyroid gland. For both the groups, we compared rates of persistent/recurrent disease and permanent hypoparathyroidism. Results Eight patients had unilateral clearance and 16 had STP. Subtotal parathyroidectomy patients were younger (37 vs 52 years). One patient in each group had persistent disease. One (13 %) unilateral clearance and five (31 %) STP patients had recurrent hyperparathyroidism after a mean follow-up of 47 and 68 months (p = 0.62). No unilateral clearance patients and two of 16 SPT patients had permanent hypoparathyroidism (p = 0.54). Conclusions Some MEN1 patients with primary hyperparathyroidism who have concordant localizing studies may be selected for unilateral clearance as an alternative to STP. For appropriately selected MEN1 patients, unilateral clearance can achieve similar results as STP and has no risk of permanent hypoparathyroidism, and may facilitate possible future reoperations. Parathyroid Gland (dpeaa)DE-He213 Primary Hyperparathyroidism (dpeaa)DE-He213 Cinacalcet (dpeaa)DE-He213 Permanent Hypoparathyroidism (dpeaa)DE-He213 Total Parathyroidectomy (dpeaa)DE-He213 Beninato, Toni aut Drake, Frederick Thurston aut Vriens, Menno R. aut Gosnell, Jessica aut Shen, Wen T. aut Suh, Insoo aut Liu, Chienying aut Duh, Quan-Yang aut Enthalten in World Journal of Surgery Springer-Verlag, 1996 40(2016), 12 vom: 11. Juli, Seite 2964-2969 (DE-627)SPR003391159 nnns volume:40 year:2016 number:12 day:11 month:07 pages:2964-2969 https://dx.doi.org/10.1007/s00268-016-3624-9 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA AR 40 2016 12 11 07 2964-2969 |
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10.1007/s00268-016-3624-9 doi (DE-627)SPR003455297 (SPR)s00268-016-3624-9-e DE-627 ger DE-627 rakwb eng Kluijfhout, Wouter P. verfasserin aut Unilateral Clearance for Primary Hyperparathyroidism in Selected Patients with Multiple Endocrine Neoplasia Type 1 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2016 Background Primary hyperparathyroidism is the most common manifestation of multiple endocrine neoplasia type 1 (MEN1). Guidelines advocate subtotal parathyroidectomy (STP) or total parathyroidectomy with autotransplantation due to high prevalence of multiglandular disease; however, both are associated with a significant risk of permanent hypoparathyroidism. More accurate imaging and use of intraoperative PTH levels may allow a less extensive initial parathyroidectomy (unilateral clearance, removing both parathyroids with cervical thymectomy) in selected MEN1 patients with primary hyperparathyroidism. Methods We performed a retrospective cohort study at a high-volume tertiary medical center including patients with MEN1 and primary hyperparathyroidism, who underwent STP or unilateral clearance as their initial surgery from 1995 to 2015. Unilateral clearance was offered to patients who had concordant sestamibi and ultrasound showing a single enlarged parathyroid gland. For both the groups, we compared rates of persistent/recurrent disease and permanent hypoparathyroidism. Results Eight patients had unilateral clearance and 16 had STP. Subtotal parathyroidectomy patients were younger (37 vs 52 years). One patient in each group had persistent disease. One (13 %) unilateral clearance and five (31 %) STP patients had recurrent hyperparathyroidism after a mean follow-up of 47 and 68 months (p = 0.62). No unilateral clearance patients and two of 16 SPT patients had permanent hypoparathyroidism (p = 0.54). Conclusions Some MEN1 patients with primary hyperparathyroidism who have concordant localizing studies may be selected for unilateral clearance as an alternative to STP. For appropriately selected MEN1 patients, unilateral clearance can achieve similar results as STP and has no risk of permanent hypoparathyroidism, and may facilitate possible future reoperations. Parathyroid Gland (dpeaa)DE-He213 Primary Hyperparathyroidism (dpeaa)DE-He213 Cinacalcet (dpeaa)DE-He213 Permanent Hypoparathyroidism (dpeaa)DE-He213 Total Parathyroidectomy (dpeaa)DE-He213 Beninato, Toni aut Drake, Frederick Thurston aut Vriens, Menno R. aut Gosnell, Jessica aut Shen, Wen T. aut Suh, Insoo aut Liu, Chienying aut Duh, Quan-Yang aut Enthalten in World Journal of Surgery Springer-Verlag, 1996 40(2016), 12 vom: 11. Juli, Seite 2964-2969 (DE-627)SPR003391159 nnns volume:40 year:2016 number:12 day:11 month:07 pages:2964-2969 https://dx.doi.org/10.1007/s00268-016-3624-9 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA AR 40 2016 12 11 07 2964-2969 |
| allfields_unstemmed |
10.1007/s00268-016-3624-9 doi (DE-627)SPR003455297 (SPR)s00268-016-3624-9-e DE-627 ger DE-627 rakwb eng Kluijfhout, Wouter P. verfasserin aut Unilateral Clearance for Primary Hyperparathyroidism in Selected Patients with Multiple Endocrine Neoplasia Type 1 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2016 Background Primary hyperparathyroidism is the most common manifestation of multiple endocrine neoplasia type 1 (MEN1). Guidelines advocate subtotal parathyroidectomy (STP) or total parathyroidectomy with autotransplantation due to high prevalence of multiglandular disease; however, both are associated with a significant risk of permanent hypoparathyroidism. More accurate imaging and use of intraoperative PTH levels may allow a less extensive initial parathyroidectomy (unilateral clearance, removing both parathyroids with cervical thymectomy) in selected MEN1 patients with primary hyperparathyroidism. Methods We performed a retrospective cohort study at a high-volume tertiary medical center including patients with MEN1 and primary hyperparathyroidism, who underwent STP or unilateral clearance as their initial surgery from 1995 to 2015. Unilateral clearance was offered to patients who had concordant sestamibi and ultrasound showing a single enlarged parathyroid gland. For both the groups, we compared rates of persistent/recurrent disease and permanent hypoparathyroidism. Results Eight patients had unilateral clearance and 16 had STP. Subtotal parathyroidectomy patients were younger (37 vs 52 years). One patient in each group had persistent disease. One (13 %) unilateral clearance and five (31 %) STP patients had recurrent hyperparathyroidism after a mean follow-up of 47 and 68 months (p = 0.62). No unilateral clearance patients and two of 16 SPT patients had permanent hypoparathyroidism (p = 0.54). Conclusions Some MEN1 patients with primary hyperparathyroidism who have concordant localizing studies may be selected for unilateral clearance as an alternative to STP. For appropriately selected MEN1 patients, unilateral clearance can achieve similar results as STP and has no risk of permanent hypoparathyroidism, and may facilitate possible future reoperations. Parathyroid Gland (dpeaa)DE-He213 Primary Hyperparathyroidism (dpeaa)DE-He213 Cinacalcet (dpeaa)DE-He213 Permanent Hypoparathyroidism (dpeaa)DE-He213 Total Parathyroidectomy (dpeaa)DE-He213 Beninato, Toni aut Drake, Frederick Thurston aut Vriens, Menno R. aut Gosnell, Jessica aut Shen, Wen T. aut Suh, Insoo aut Liu, Chienying aut Duh, Quan-Yang aut Enthalten in World Journal of Surgery Springer-Verlag, 1996 40(2016), 12 vom: 11. Juli, Seite 2964-2969 (DE-627)SPR003391159 nnns volume:40 year:2016 number:12 day:11 month:07 pages:2964-2969 https://dx.doi.org/10.1007/s00268-016-3624-9 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA AR 40 2016 12 11 07 2964-2969 |
| allfieldsGer |
10.1007/s00268-016-3624-9 doi (DE-627)SPR003455297 (SPR)s00268-016-3624-9-e DE-627 ger DE-627 rakwb eng Kluijfhout, Wouter P. verfasserin aut Unilateral Clearance for Primary Hyperparathyroidism in Selected Patients with Multiple Endocrine Neoplasia Type 1 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2016 Background Primary hyperparathyroidism is the most common manifestation of multiple endocrine neoplasia type 1 (MEN1). Guidelines advocate subtotal parathyroidectomy (STP) or total parathyroidectomy with autotransplantation due to high prevalence of multiglandular disease; however, both are associated with a significant risk of permanent hypoparathyroidism. More accurate imaging and use of intraoperative PTH levels may allow a less extensive initial parathyroidectomy (unilateral clearance, removing both parathyroids with cervical thymectomy) in selected MEN1 patients with primary hyperparathyroidism. Methods We performed a retrospective cohort study at a high-volume tertiary medical center including patients with MEN1 and primary hyperparathyroidism, who underwent STP or unilateral clearance as their initial surgery from 1995 to 2015. Unilateral clearance was offered to patients who had concordant sestamibi and ultrasound showing a single enlarged parathyroid gland. For both the groups, we compared rates of persistent/recurrent disease and permanent hypoparathyroidism. Results Eight patients had unilateral clearance and 16 had STP. Subtotal parathyroidectomy patients were younger (37 vs 52 years). One patient in each group had persistent disease. One (13 %) unilateral clearance and five (31 %) STP patients had recurrent hyperparathyroidism after a mean follow-up of 47 and 68 months (p = 0.62). No unilateral clearance patients and two of 16 SPT patients had permanent hypoparathyroidism (p = 0.54). Conclusions Some MEN1 patients with primary hyperparathyroidism who have concordant localizing studies may be selected for unilateral clearance as an alternative to STP. For appropriately selected MEN1 patients, unilateral clearance can achieve similar results as STP and has no risk of permanent hypoparathyroidism, and may facilitate possible future reoperations. Parathyroid Gland (dpeaa)DE-He213 Primary Hyperparathyroidism (dpeaa)DE-He213 Cinacalcet (dpeaa)DE-He213 Permanent Hypoparathyroidism (dpeaa)DE-He213 Total Parathyroidectomy (dpeaa)DE-He213 Beninato, Toni aut Drake, Frederick Thurston aut Vriens, Menno R. aut Gosnell, Jessica aut Shen, Wen T. aut Suh, Insoo aut Liu, Chienying aut Duh, Quan-Yang aut Enthalten in World Journal of Surgery Springer-Verlag, 1996 40(2016), 12 vom: 11. Juli, Seite 2964-2969 (DE-627)SPR003391159 nnns volume:40 year:2016 number:12 day:11 month:07 pages:2964-2969 https://dx.doi.org/10.1007/s00268-016-3624-9 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA AR 40 2016 12 11 07 2964-2969 |
| allfieldsSound |
10.1007/s00268-016-3624-9 doi (DE-627)SPR003455297 (SPR)s00268-016-3624-9-e DE-627 ger DE-627 rakwb eng Kluijfhout, Wouter P. verfasserin aut Unilateral Clearance for Primary Hyperparathyroidism in Selected Patients with Multiple Endocrine Neoplasia Type 1 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2016 Background Primary hyperparathyroidism is the most common manifestation of multiple endocrine neoplasia type 1 (MEN1). Guidelines advocate subtotal parathyroidectomy (STP) or total parathyroidectomy with autotransplantation due to high prevalence of multiglandular disease; however, both are associated with a significant risk of permanent hypoparathyroidism. More accurate imaging and use of intraoperative PTH levels may allow a less extensive initial parathyroidectomy (unilateral clearance, removing both parathyroids with cervical thymectomy) in selected MEN1 patients with primary hyperparathyroidism. Methods We performed a retrospective cohort study at a high-volume tertiary medical center including patients with MEN1 and primary hyperparathyroidism, who underwent STP or unilateral clearance as their initial surgery from 1995 to 2015. Unilateral clearance was offered to patients who had concordant sestamibi and ultrasound showing a single enlarged parathyroid gland. For both the groups, we compared rates of persistent/recurrent disease and permanent hypoparathyroidism. Results Eight patients had unilateral clearance and 16 had STP. Subtotal parathyroidectomy patients were younger (37 vs 52 years). One patient in each group had persistent disease. One (13 %) unilateral clearance and five (31 %) STP patients had recurrent hyperparathyroidism after a mean follow-up of 47 and 68 months (p = 0.62). No unilateral clearance patients and two of 16 SPT patients had permanent hypoparathyroidism (p = 0.54). Conclusions Some MEN1 patients with primary hyperparathyroidism who have concordant localizing studies may be selected for unilateral clearance as an alternative to STP. For appropriately selected MEN1 patients, unilateral clearance can achieve similar results as STP and has no risk of permanent hypoparathyroidism, and may facilitate possible future reoperations. Parathyroid Gland (dpeaa)DE-He213 Primary Hyperparathyroidism (dpeaa)DE-He213 Cinacalcet (dpeaa)DE-He213 Permanent Hypoparathyroidism (dpeaa)DE-He213 Total Parathyroidectomy (dpeaa)DE-He213 Beninato, Toni aut Drake, Frederick Thurston aut Vriens, Menno R. aut Gosnell, Jessica aut Shen, Wen T. aut Suh, Insoo aut Liu, Chienying aut Duh, Quan-Yang aut Enthalten in World Journal of Surgery Springer-Verlag, 1996 40(2016), 12 vom: 11. Juli, Seite 2964-2969 (DE-627)SPR003391159 nnns volume:40 year:2016 number:12 day:11 month:07 pages:2964-2969 https://dx.doi.org/10.1007/s00268-016-3624-9 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA AR 40 2016 12 11 07 2964-2969 |
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Guidelines advocate subtotal parathyroidectomy (STP) or total parathyroidectomy with autotransplantation due to high prevalence of multiglandular disease; however, both are associated with a significant risk of permanent hypoparathyroidism. More accurate imaging and use of intraoperative PTH levels may allow a less extensive initial parathyroidectomy (unilateral clearance, removing both parathyroids with cervical thymectomy) in selected MEN1 patients with primary hyperparathyroidism. Methods We performed a retrospective cohort study at a high-volume tertiary medical center including patients with MEN1 and primary hyperparathyroidism, who underwent STP or unilateral clearance as their initial surgery from 1995 to 2015. Unilateral clearance was offered to patients who had concordant sestamibi and ultrasound showing a single enlarged parathyroid gland. For both the groups, we compared rates of persistent/recurrent disease and permanent hypoparathyroidism. Results Eight patients had unilateral clearance and 16 had STP. Subtotal parathyroidectomy patients were younger (37 vs 52 years). One patient in each group had persistent disease. One (13 %) unilateral clearance and five (31 %) STP patients had recurrent hyperparathyroidism after a mean follow-up of 47 and 68 months (p = 0.62). No unilateral clearance patients and two of 16 SPT patients had permanent hypoparathyroidism (p = 0.54). Conclusions Some MEN1 patients with primary hyperparathyroidism who have concordant localizing studies may be selected for unilateral clearance as an alternative to STP. 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Kluijfhout, Wouter P. |
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Kluijfhout, Wouter P. misc Parathyroid Gland misc Primary Hyperparathyroidism misc Cinacalcet misc Permanent Hypoparathyroidism misc Total Parathyroidectomy Unilateral Clearance for Primary Hyperparathyroidism in Selected Patients with Multiple Endocrine Neoplasia Type 1 |
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Unilateral Clearance for Primary Hyperparathyroidism in Selected Patients with Multiple Endocrine Neoplasia Type 1 Parathyroid Gland (dpeaa)DE-He213 Primary Hyperparathyroidism (dpeaa)DE-He213 Cinacalcet (dpeaa)DE-He213 Permanent Hypoparathyroidism (dpeaa)DE-He213 Total Parathyroidectomy (dpeaa)DE-He213 |
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Kluijfhout, Wouter P. Beninato, Toni Drake, Frederick Thurston Vriens, Menno R. Gosnell, Jessica Shen, Wen T. Suh, Insoo Liu, Chienying Duh, Quan-Yang |
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unilateral clearance for primary hyperparathyroidism in selected patients with multiple endocrine neoplasia type 1 |
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Unilateral Clearance for Primary Hyperparathyroidism in Selected Patients with Multiple Endocrine Neoplasia Type 1 |
| abstract |
Background Primary hyperparathyroidism is the most common manifestation of multiple endocrine neoplasia type 1 (MEN1). Guidelines advocate subtotal parathyroidectomy (STP) or total parathyroidectomy with autotransplantation due to high prevalence of multiglandular disease; however, both are associated with a significant risk of permanent hypoparathyroidism. More accurate imaging and use of intraoperative PTH levels may allow a less extensive initial parathyroidectomy (unilateral clearance, removing both parathyroids with cervical thymectomy) in selected MEN1 patients with primary hyperparathyroidism. Methods We performed a retrospective cohort study at a high-volume tertiary medical center including patients with MEN1 and primary hyperparathyroidism, who underwent STP or unilateral clearance as their initial surgery from 1995 to 2015. Unilateral clearance was offered to patients who had concordant sestamibi and ultrasound showing a single enlarged parathyroid gland. For both the groups, we compared rates of persistent/recurrent disease and permanent hypoparathyroidism. Results Eight patients had unilateral clearance and 16 had STP. Subtotal parathyroidectomy patients were younger (37 vs 52 years). One patient in each group had persistent disease. One (13 %) unilateral clearance and five (31 %) STP patients had recurrent hyperparathyroidism after a mean follow-up of 47 and 68 months (p = 0.62). No unilateral clearance patients and two of 16 SPT patients had permanent hypoparathyroidism (p = 0.54). Conclusions Some MEN1 patients with primary hyperparathyroidism who have concordant localizing studies may be selected for unilateral clearance as an alternative to STP. For appropriately selected MEN1 patients, unilateral clearance can achieve similar results as STP and has no risk of permanent hypoparathyroidism, and may facilitate possible future reoperations. © The Author(s) 2016 |
| abstractGer |
Background Primary hyperparathyroidism is the most common manifestation of multiple endocrine neoplasia type 1 (MEN1). Guidelines advocate subtotal parathyroidectomy (STP) or total parathyroidectomy with autotransplantation due to high prevalence of multiglandular disease; however, both are associated with a significant risk of permanent hypoparathyroidism. More accurate imaging and use of intraoperative PTH levels may allow a less extensive initial parathyroidectomy (unilateral clearance, removing both parathyroids with cervical thymectomy) in selected MEN1 patients with primary hyperparathyroidism. Methods We performed a retrospective cohort study at a high-volume tertiary medical center including patients with MEN1 and primary hyperparathyroidism, who underwent STP or unilateral clearance as their initial surgery from 1995 to 2015. Unilateral clearance was offered to patients who had concordant sestamibi and ultrasound showing a single enlarged parathyroid gland. For both the groups, we compared rates of persistent/recurrent disease and permanent hypoparathyroidism. Results Eight patients had unilateral clearance and 16 had STP. Subtotal parathyroidectomy patients were younger (37 vs 52 years). One patient in each group had persistent disease. One (13 %) unilateral clearance and five (31 %) STP patients had recurrent hyperparathyroidism after a mean follow-up of 47 and 68 months (p = 0.62). No unilateral clearance patients and two of 16 SPT patients had permanent hypoparathyroidism (p = 0.54). Conclusions Some MEN1 patients with primary hyperparathyroidism who have concordant localizing studies may be selected for unilateral clearance as an alternative to STP. For appropriately selected MEN1 patients, unilateral clearance can achieve similar results as STP and has no risk of permanent hypoparathyroidism, and may facilitate possible future reoperations. © The Author(s) 2016 |
| abstract_unstemmed |
Background Primary hyperparathyroidism is the most common manifestation of multiple endocrine neoplasia type 1 (MEN1). Guidelines advocate subtotal parathyroidectomy (STP) or total parathyroidectomy with autotransplantation due to high prevalence of multiglandular disease; however, both are associated with a significant risk of permanent hypoparathyroidism. More accurate imaging and use of intraoperative PTH levels may allow a less extensive initial parathyroidectomy (unilateral clearance, removing both parathyroids with cervical thymectomy) in selected MEN1 patients with primary hyperparathyroidism. Methods We performed a retrospective cohort study at a high-volume tertiary medical center including patients with MEN1 and primary hyperparathyroidism, who underwent STP or unilateral clearance as their initial surgery from 1995 to 2015. Unilateral clearance was offered to patients who had concordant sestamibi and ultrasound showing a single enlarged parathyroid gland. For both the groups, we compared rates of persistent/recurrent disease and permanent hypoparathyroidism. Results Eight patients had unilateral clearance and 16 had STP. Subtotal parathyroidectomy patients were younger (37 vs 52 years). One patient in each group had persistent disease. One (13 %) unilateral clearance and five (31 %) STP patients had recurrent hyperparathyroidism after a mean follow-up of 47 and 68 months (p = 0.62). No unilateral clearance patients and two of 16 SPT patients had permanent hypoparathyroidism (p = 0.54). Conclusions Some MEN1 patients with primary hyperparathyroidism who have concordant localizing studies may be selected for unilateral clearance as an alternative to STP. For appropriately selected MEN1 patients, unilateral clearance can achieve similar results as STP and has no risk of permanent hypoparathyroidism, and may facilitate possible future reoperations. © The Author(s) 2016 |
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Unilateral Clearance for Primary Hyperparathyroidism in Selected Patients with Multiple Endocrine Neoplasia Type 1 |
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Beninato, Toni Drake, Frederick Thurston Vriens, Menno R. Gosnell, Jessica Shen, Wen T. Suh, Insoo Liu, Chienying Duh, Quan-Yang |
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