Parathyroid surgery in the multiple endocrine neoplasia type I syndrome: Choice of surgical procedure

Abstract

Thirty‐nine patients with hyperparathyroidism (HPT) in association with the multiple endocrine neoplasia type I (MEN‐I) syndrome underwent parathyroid surgery from 1961 to 1985. Twenty‐one patients underwent resection of 1–21/2 glands, 6 had 3–31/2 glands removed, and 18 (9 of whom had previously been subjected to parathyroid surgery) underwent total parathyroidectomy with autotransplantation to the forearm. Resection of 1–21/2 glands resulted in persistent or recurrent HPT in 18 (88%) of the 21 cases. Two (33%) of the 6 patients who underwent 3–31/2‐gland resection had recurrent disease. After total parathyroidectomy with autotransplantation to the forearm, no patient had persistent or recurrent HPT. Five (26%) of 18 patients had permanent hypocalcemia requiring supplemental therapy. After a change in the operative technique, however, only 1 of 10 was permanently hypocalcemic. It is concluded that primary HPT in the MEN‐I syndrome always should be treated with radical surgery. Total parathyroidectomy with autotransplantation seems more favorable than 3–31/2‐gland resection owing to the absence of recurrent HPT in this material and the limited number of patients with long‐standing postoperative hypocalcemia, provided that an optimal technique for autotransplantation was performed.

A randomized, prospective trial of operative treatments for hyperparathyroidism in patients with multiple endocrine neoplasia type 1

“…Nevertheless, several retrospective series have compared the results of different operative procedures, collectively representing a large number of patients. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] The interpretation of results from these comparisons is complicated by potential differences in patient selection, surgeon preferences or biases, variation in operative technique or extent of operative resection of the parathyroid glands, and lack of complete follow-up. Until the current study, a randomized, prospective evaluation of outcomes comparing the 2 commonly performed operations for HPT in MEN 1 has been lacking.…”

“…5,7,8,[10][11][12][14][15][16][17][18][19][20][21]25 Series of total parathyroidectomy report recurrent HPT in 11-57% of cases and permanent hypoparathyroidism in #67%. 6,9,12,14,[18][19][20][21]23 This study represents the first prospective analysis of patients randomized to either SP or TP/AT with direct comparison of outcomes between the 2 groups. Only 1 patient in our study had persistent HPT.…”

“…Despite the potential advantages and disadvantages of these 2 commonly practiced operations, previous retrospective studies have demonstrated similar overall rates of recurrent HPT and permanent postoperative hypoparathyroidism in patients undergoing the 2 operations. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Although one of these approaches is often preferred by individual expert endocrine surgery groups, improved outcomes or a clear advantage for either operation has not been established by previous studies. This randomized, prospective trial compared the results of TP/AT with SP for the treatment of patients with HPT and MEN 1.…”

Insulinoma Associated with a Case of Multiple Endocrine Neoplasia Type I: Functional Somatostatin Receptors and Abnormal Glucose-Induced Insulin Secretion

“…Aggressive surgery has also been advocated for hyper parathyroidism associated with MEN1 including total parathyroidectomy and forearm autotransplantation [12], Parathyroid surgery in MEN1 results in an initial cure rate of approximately 75%, but recurrence of hypercal cemia occurs in approximately half of the cases during a 10-year period [13]. Our patient showed early recurrence.…”

Parathyroid hormone release in vitro in hyperparathyroidism associated with multiple endocrine neoplasia type 1

“…Histopathological examination substan¬ tiated the diagnosis of parathyroid hyperplasia in all the patients. After autotransplantation to the forearm of approximately 60 mg of parathyroid tissue (cf Malmaeus et al 1986), all remaining tissue from each MEN-1 patient was handled together in the investiga¬ tion of dispersed cells except in 3 patients in whom two-three glands were treated separately. Single parathyroid adenomas were obtained from 10 patients with serum calcium values from 2.62-3. fO mmol/1 ( Table 1).…”