The outcome of subtotal parathyroidectomy for the treatment of hyperparathyroidism in multiple endocrine neoplasia type 1.

Abstract

BACKGROUND:

The efficacy of subtotal parathyroidectomy for the treatment of hyperparathyroidism in multiple endocrine neoplasia type 1 (MEN 1) is unclear. The long-term outcome and optimal timing of operation remain controversial.

OBJECTIVE:

To determine the long-term outcome of parathyroidectomy for primary hyperparathyroidism in the presence of MEN 1.

DESIGN:

Case series and retrospective analysis.

SETTING:

Tertiary referral center.

PATIENTS:

Patients with MEN 1 from 2 families.

INTERVENTIONS:

Subtotal parathyroidectomy, ie, resection of 3 1/2 parathyroid glands from each patient.

MAIN OUTCOME MEASURES:

Recurrence of hyperparathyroidism.

RESULTS:

Thirty-seven patients underwent subtotal parathyroidectomy. Overall, persistent postoperative hypoparathyroidism developed in 24%, normocalcemia was maintained in 46%, and hyperparathyroidism recurred in 30%. However, after adjustment for the duration of follow-up (by using the Kaplan-Meier method), the cumulative recurrence rates for hyperparathyroidism were 15% at 2 years, 23% at 4 years, 55% at 8 years, and 67% after 8 years. Early recurrence of hyperparathyroidism (within 5 years of operation) was less likely to develop in patients in whom ionized calcium levels of 1.00 mmol/L (4.00 mg/dL) or less were achieved during the perioperative period than in patients in whom this degree of hypocalcemia failed to develop (P=.01).

CONCLUSIONS:

While relatively long periods of disease remission are possible after subtotal parathyroidectomy, our results indicate that recurrent hyperparathyroidism eventually develops in most patients with MEN 1.

• Authors: J R Burgess, R David, V Parameswaran, T M Greenaway, J J Shepherd
• Journal: Archives of surgery (Chicago, Ill. : 1960) (Arch Surg) Vol. 133 Issue 2 Pg. 126-9 (Feb 1998) ISSN: 0004-0010 [Print] United States
• PMID: 9484721 (Publication Type: Journal Article)

Chemical References

• Calcium

Topics

• Adult
• Calcium (blood)
• Female
• Humans
• Hyperparathyroidism (blood, etiology, surgery)
• Male
• Multiple Endocrine Neoplasia Type 1 (blood, complications)
• Parathyroid Neoplasms (blood, complications)
• Parathyroidectomy (methods)
• Retrospective Studies
• Treatment Outcome