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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 associa...

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Autores principales: Kluijfhout, Wouter P., Beninato, Toni, Drake, Frederick Thurston, Vriens, Menno R., Gosnell, Jessica, Shen, Wen T., Suh, Insoo, Liu, Chienying, Duh, Quan-Yang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5104782/
https://www.ncbi.nlm.nih.gov/pubmed/27402205
http://dx.doi.org/10.1007/s00268-016-3624-9
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author Kluijfhout, Wouter P.
Beninato, Toni
Drake, Frederick Thurston
Vriens, Menno R.
Gosnell, Jessica
Shen, Wen T.
Suh, Insoo
Liu, Chienying
Duh, Quan-Yang
author_facet Kluijfhout, Wouter P.
Beninato, Toni
Drake, Frederick Thurston
Vriens, Menno R.
Gosnell, Jessica
Shen, Wen T.
Suh, Insoo
Liu, Chienying
Duh, Quan-Yang
author_sort Kluijfhout, Wouter P.
collection PubMed
description 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.
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spelling pubmed-51047822016-11-25 Unilateral Clearance for Primary Hyperparathyroidism in Selected Patients with Multiple Endocrine Neoplasia Type 1 Kluijfhout, Wouter P. Beninato, Toni Drake, Frederick Thurston Vriens, Menno R. Gosnell, Jessica Shen, Wen T. Suh, Insoo Liu, Chienying Duh, Quan-Yang World J Surg Original Scientific Report 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. Springer International Publishing 2016-07-11 2016 /pmc/articles/PMC5104782/ /pubmed/27402205 http://dx.doi.org/10.1007/s00268-016-3624-9 Text en © The Author(s) 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Scientific Report
Kluijfhout, Wouter P.
Beninato, Toni
Drake, Frederick Thurston
Vriens, Menno R.
Gosnell, Jessica
Shen, Wen T.
Suh, Insoo
Liu, Chienying
Duh, Quan-Yang
Unilateral Clearance for Primary Hyperparathyroidism in Selected Patients with Multiple Endocrine Neoplasia Type 1
title Unilateral Clearance for Primary Hyperparathyroidism in Selected Patients with Multiple Endocrine Neoplasia Type 1
title_full Unilateral Clearance for Primary Hyperparathyroidism in Selected Patients with Multiple Endocrine Neoplasia Type 1
title_fullStr Unilateral Clearance for Primary Hyperparathyroidism in Selected Patients with Multiple Endocrine Neoplasia Type 1
title_full_unstemmed Unilateral Clearance for Primary Hyperparathyroidism in Selected Patients with Multiple Endocrine Neoplasia Type 1
title_short Unilateral Clearance for Primary Hyperparathyroidism in Selected Patients with Multiple Endocrine Neoplasia Type 1
title_sort unilateral clearance for primary hyperparathyroidism in selected patients with multiple endocrine neoplasia type 1
topic Original Scientific Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5104782/
https://www.ncbi.nlm.nih.gov/pubmed/27402205
http://dx.doi.org/10.1007/s00268-016-3624-9
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