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Unilateral Clearance for Primary Hyperparathyroidism in Selected Patients with Multiple Endocrine Neoplasia Type 1.
Published Web Location
http://download.springer.com/static/pdf/674/art%253A10.1007%252Fs00268-016-3624-9.pdf?originUrl=http://link.springer.com/article/10.1007/s00268-016-3624-9&token2=exp=1487373565~acl=/static/pdf/674/art%25253A10.1007%25252Fs00268-016-3624-9.pdf?originUrl=http%253A%252F%252Flink.springer.com%252Farticle%252F10.1007%252Fs00268-016-3624-9*~hmac=7510d3992b1203a56110816b029200ebf06cb4743254327b7eea97f48d192a3bNo data is associated with this publication.
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.Many UC-authored scholarly publications are freely available on this site because of the UC's open access policies. Let us know how this access is important for you.