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Surgery for multiple endocrine neoplasia type 1-associated primary hyperparathyroidism
J Waldmann1, C L López, P Langer
1Department of Visceral, Thoracic and Vascular Surgery, University Hospital Giessen and Marburg, Marburg, Germany. jwaldman@med.uni-marburg.de
The British Journal of Surgery
|July 15, 2010
Summary
For multiple endocrine neoplasia type 1 (MEN1)-associated primary hyperparathyroidism (pHPT), total parathyroidectomy with autotransplantation (TPTX + AT) and subtotal parathyroidectomy (SPTX) offer comparable outcomes. Selective gland excision leads to higher recurrence rates.
Area of Science:
- Endocrinology
- Surgical Oncology
- Genetics
Background:
- Multiple endocrine neoplasia type 1 (MEN1) causes complex primary hyperparathyroidism (pHPT) due to asymmetrical hyperplasia.
- Optimal surgical management for long-term normocalcemia in MEN1-associated pHPT remains debated.
Purpose of the Study:
- To compare the long-term efficacy of different surgical procedures for MEN1-associated primary hyperparathyroidism.
Main Methods:
- Retrospective analysis of a prospective database of patients with genetically confirmed MEN1-associated pHPT who underwent surgery between 1987 and 2009.
- Evaluation of clinical data, operative procedures (total parathyroidectomy with autotransplantation, subtotal parathyroidectomy, selective gland excision), and patient outcomes.
Main Results:
- Total parathyroidectomy with autotransplantation (TPTX + AT) had low rates of persistent (4%) and recurrent (4%) disease, with 22% permanent hypoparathyroidism.
- Subtotal parathyroidectomy (SPTX) showed no persistent disease, 18% recurrence, and 45% permanent hypoparathyroidism; these rates were not significantly different from TPTX + AT.
- Selective gland excision (SGE) resulted in 23% persistent disease and a significantly higher recurrence rate (46%) compared to TPTX + AT and SPTX.
Conclusions:
- Both TPTX + AT and SPTX are effective surgical options for MEN1-associated pHPT, demonstrating similar recurrence rates.
- SGE is associated with a higher risk of disease recurrence in MEN1-associated pHPT patients.
