Single gland excision for MEN1‐associated primary hyperparathyroidism

Manoharan, Jerena; Albers, Max B.; Bollmann, Carmen; Maurer, Elisabeth; Mintziras, Ioannis; Wächter, Sabine; Bartsch, Detlef K.

doi:10.1111/cen.14112

Cited by 22 publications

(19 citation statements)

References 40 publications

(90 reference statements)

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“…Unlike its sporadic counterpart, MEN1 related HPT occurs at an earlier age (33 years of age vs. 63 years) and characteristically shows multiple gland involvement. Surgery is the treatment of choice for MEN1 HPT, although the most appropriate timing and surgical approach are debated, and undoubtedly there is a higher persistence and recurrence rate compared with sporadic disease [117,118]. Nephrolithiasis and early bone mineral loss are frequent, extensive, and progressively worsen during the course of the disease.…”

Section: Gep-net Associated To Men1 and Bone Healthmentioning

confidence: 99%

Bone Metabolism and Vitamin D Implication in Gastroenteropancreatic Neuroendocrine Tumors

Altieri¹,

Dato

Modica

et al. 2020

Nutrients

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Patients affected by gastroenteropancreatic–neuroendocrine tumors (GEP–NETs) have an increased risk of developing osteopenia and osteoporosis, as several factors impact on bone metabolism in these patients. In fact, besides the direct effect of bone metastasis, bone health can be affected by hormone hypersecretion (including serotonin, cortisol, and parathyroid hormone-related protein), specific microRNAs, nutritional status (which in turn could be affected by medical and surgical treatments), and vitamin D deficiency. In patients with multiple endocrine neoplasia type 1 (MEN1), a hereditary syndrome associated with NET occurrence, bone damage may carry other consequences. Osteoporosis may negatively impact on the quality of life of these patients and can increment the cost of medical care since these patients usually live with their disease for a long time. However, recommendations suggesting screening to assess bone health in GEP–NET patients are missing. The aim of this review is to critically analyze evidence on the mechanisms that could have a potential impact on bone health in patients affected by GEP–NET, focusing on vitamin D and its role in GEP–NET, as well as on factors associated with MEN1 that could have an impact on bone homeostasis.

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Section: Gep-net Associated To Men1 and Bone Healthmentioning

confidence: 99%

Bone Metabolism and Vitamin D Implication in Gastroenteropancreatic Neuroendocrine Tumors

Altieri¹,

Dato

Modica

et al. 2020

Nutrients

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“…This latter procedure consists in leaving a normal parathyroid or a parathyroid fragment equal in size to a normal gland in situ coupled ideally with a bilateral cervical thymic horn excision 4 . TPT is a more radical procedure, which should lead to a lower rate of postoperative persistence and a lower rate of recurrence or 5,7 . These apparent advantages or by a higher rate of permanent hypoparathyroidism, despite parathyroid tissue autotransplantation, when compared to SPT 8,9 .…”

Section: Introductionmentioning

confidence: 99%

“…laryngeal nerve injury or long term hypoparathyroidism) and facilitate subsequent neck explorations. This is described as less than subtotal parathyroidectomy (LSPT) 7,10 that encompasses a variety of strategies including minimally invasive, single, two or three gland excisions 7,8 . The LSPT overall has failed to gain traction due to poor recurrence rates and disease persistence outcomes 9,11 .…”

Section: Introductionmentioning

confidence: 99%

Optimal extent of initial parathyroid resection in patients with multiple endocrine neoplasia syndrome type 1: A meta-analysis

Nastos

Papaconstantinou

Kofopoulos-Lymperis

et al. 2021

Surgery

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“…In recent years it has been debated if for young people with MEN1-related pHPT, a stepwise approach to parathyroid surgery should be offered in the form of unilateral clearance (resection of all parathyroids and cervical thymus on one side) as initial operation. [38][39][40][41] The rationale for considering this in those with unilateral disease on preoperative imaging, is to provide several years of eucalcemia allowing to accumulate peak bone mass, while not being subjected to the risk of hypoparathyroidism. Others are fiercely opposed such an approach, due to unacceptable failure rates.…”

Section: Primary Hyperparathyroidismmentioning

confidence: 99%

Update on the clinical management of multiple endocrine neoplasia type 1

Pieterman

Valk

2022

Clinical Endocrinology

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This review provides an overview of novel insights in the clinical management of patients with Multiple Endocrine Neoplasia Type 1, focusing on the last decade since the last update of the MEN1 guidelines. With regard to Diagnosis: Mutation‐negative patients with 2/3 main manifestations have a different clinical course compared to mutation‐positive patients. As for primary hyperparathyroidism: subtotal parathyroidectomy is the initial procedure of choice. Current debate centres around the timing of initial parathyroidectomy as well as the controversial topic of unilateral clearance in young patients. For duodenopancreatic neuroendocrine tumours (NETs), the main challenge is accurate and individualized risk stratification to enable personalized surveillance and treatment. Thymus NETs remain one of the most aggressive MEN1‐related tumours. Lung NETs are more frequent than previously thought, generally indolent, but rare aggressive cases do occur. Pituitary adenomas are most often prolactinomas and nonfunctioning microadenomas with an excellent prognosis and good response to therapy. Breast cancer is recognized as part of the MEN1 syndrome in women and periodical screening is advised. Clinically relevant manifestations are already seen at the paediatric age and initiating screening in the second decade is advisable. MEN1 has a significant impact on quality of life and US data show a significant financial burden. In conclusion, patient outcomes have improved, but much is still to be achieved. For care tailored to the needs of the individual patient and improving outcomes on an individual basis, studies are now needed to define predictors of tumour behaviour and effects of more individualized interventions.

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Single gland excision for MEN1‐associated primary hyperparathyroidism

Cited by 22 publications

References 40 publications

Bone Metabolism and Vitamin D Implication in Gastroenteropancreatic Neuroendocrine Tumors

Bone Metabolism and Vitamin D Implication in Gastroenteropancreatic Neuroendocrine Tumors

Optimal extent of initial parathyroid resection in patients with multiple endocrine neoplasia syndrome type 1: A meta-analysis

Update on the clinical management of multiple endocrine neoplasia type 1

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