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Related Concept Videos

The Parathyroid Glands00:59

The Parathyroid Glands

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The two pairs of parathyroid glands embedded within the posterior surface of the thyroid gland are restricted by a dense capsule around them. These glands comprise two distinct cell populations—parathyroid oxyphil and parathyroid principal cells- pivotal in calcium homeostasis.
Oxyphil cells, whose functions remain elusive, emerge during late puberty, adding a layer of complexity to the parathyroid gland's intricacies. In contrast, principal parathyroid cells undertake a vital role by...
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Related Experiment Video

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Gasless Endoscopic Thyroidectomy via the Trans-Axillary Approach
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Single gland excision for MEN1-associated primary hyperparathyroidism.

Jerena Manoharan1, Max B Albers1, Carmen Bollmann1

  • 1Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Marburg, Germany.

Clinical Endocrinology
|October 19, 2019
PubMed
Summary

Single gland excision (SGE) offers a viable surgical option for primary hyperparathyroidism in multiple endocrine neoplasia type 1 (MEN1), avoiding the high risk of permanent hypoparathyroidism seen with other procedures. This approach demonstrates comparable long-term efficacy with reduced complications.

Keywords:
hypocalcemiahypoparathyroidismlaryngeal nerve palsymultiple endocrine neoplasia type 1primary hyperparathyroidismrecurrencesurgery

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Area of Science:

  • Endocrinology
  • Surgical Oncology
  • Genetics

Background:

  • Primary hyperparathyroidism (pHPT) in multiple endocrine neoplasia type 1 (MEN1) is typically managed with subtotal parathyroidectomy (SPTX) or total parathyroidectomy with autotransplantation (TPTX).
  • These standard procedures carry a significant risk of permanent hypoparathyroidism, impacting patient quality of life.

Purpose of the Study:

  • To compare the long-term outcomes of single gland excision (SGE), SPTX, and TPTX for treating MEN1-associated pHPT.
  • To evaluate the rates of disease persistence, recurrence, and permanent hypoparathyroidism across different surgical techniques.

Main Methods:

  • Retrospective analysis of prospectively collected data from genetically confirmed MEN1 patients who underwent surgery for pHPT between 1987 and 2017.
  • Comparison of TPTX (n=38), SPTX (n=23), and SGE (n=28) groups regarding disease persistence, recurrence rates, recurrence-free time, and incidence of permanent hypoparathyroidism.

Main Results:

  • Disease persistence rates were 2.6% (TPTX), 0% (SPTX), and 14.2% (SGE).
  • Recurrent pHPT rates were significantly higher in the SGE group (21.3%) compared to TPTX (4.4%) and SPTX (10.1%).
  • Permanent hypoparathyroidism occurred in 32% after TPTX, 17% after SPTX, and 0% after SGE.

Conclusions:

  • Single gland excision (SGE) is a valid and safe surgical option for MEN1-associated pHPT, associated with a lower risk of permanent hypoparathyroidism.
  • While SPTX and TPTX show lower recurrence rates, the high incidence of permanent hypoparathyroidism necessitates careful consideration of SGE, particularly in select patient populations.