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Hyperparathyroidism in multiple endocrine neoplasia syndrome
J L Kraimps1, Q Y Duh, M Demeure
1Surgical Service, Mount Zion Medical Center, University of California, San Francisco 94120.
Surgery
|December 1, 1992
Summary
Parathyroidectomy outcomes vary for primary hyperparathyroidism and multiple endocrine neoplasia (MEN) syndrome. Hyperplasia cases frequently experience persistent or recurrent disease, unlike those with solitary or double adenomas.
Area of Science:
- Endocrinology
- Surgical Oncology
- Genetics
Background:
- Analysis of 42 patients with primary hyperparathyroidism and Multiple Endocrine Neoplasia (MEN) syndrome treated between 1936-1988.
- Focus on parathyroidectomy outcomes and reasons for surgical failure.
Purpose of the Study:
- To document parathyroidectomy results in patients with primary hyperparathyroidism and MEN syndrome.
- To identify causes of failed parathyroid operations.
Main Methods:
- Surgical treatment of 40 patients (38 MEN 1, 4 MEN 2A).
- Subtotal parathyroidectomy for hyperplasia; removal of adenomas with or without biopsy of normal glands.
- Reoperation for persistent or recurrent hyperparathyroidism in 11 referred patients.
Main Results:
- Recurrent hyperparathyroidism occurred in 50% of hyperplasia cases, 16% of solitary adenomas, and 14% of double adenomas.
- Failure in hyperplasia linked to missed supernumerary or ectopic glands (13-33%).
- No persistent/recurrent disease in MEN 2A; hypoparathyroidism in 1 MEN 2A and 3 MEN 1 patients.
Conclusions:
- Patients with primary hyperparathyroidism and MEN syndrome present distinct surgical outcomes based on gland pathology.
- Solitary/double adenomas are associated with uncommon recurrence post-parathyroidectomy.
- Hyperplasia is linked to common persistent or recurrent hyperparathyroidism, necessitating careful surgical management.