PMID- 26541865
OWN - NLM
STAT- MEDLINE
DCOM- 20160929
LR  - 20181202
IS  - 1432-2323 (Electronic)
IS  - 0364-2313 (Linking)
VI  - 40
IP  - 3
DP  - 2016 Mar
TI  - Long-Term Surveillance of Treated Hyperparathyroidism for Multiple Endocrine 
      Neoplasia Type 1: Recurrence or Hypoparathyroidism?
PG  - 615-21
LID - 10.1007/s00268-015-3297-9 [doi]
AB  - BACKGROUND: Primary hyperparathyroidism (HPT) in multiple endocrine neoplasia 
      type 1 (MEN1) is surgically treated with either a subtotal parathyroidectomy 
      removing 3 or 3,5 glands (SPX), less than 3 glands (LSPX), or a total 
      parathyroidectomy with autotransplantation (TPX). Previous studies with shorter 
      follow-up have shown that LSPX and SPX are associated with recurrent HPT, and TPX 
      with hypocalcemia and substitution therapy. We examined the situation after 
      long-term follow-up (median 20,6 years). METHODS: Sixty-nine patients with MEN1 
      HPT underwent 110 operations, the first operation being 31 LSPX, 30 SPX, and 8 
      TPX. Thirty patients underwent reoperative surgery in median 120 months later, as 
      completion to TPX (n = 12), completion of LSPX to SPX (n = 9), extirpation of 
      single glands (n = 3) still resulting in LSPX, and resection of forearm grafts (n 
      = 3). Nine patients underwent a second, and 2 a third reoperation. In 24 patients 
      genetic testing confirmed MEN1, and in the remaining heredity and phenotype led 
      to the diagnosis. RESULTS: TPX had higher risk for hypoparathyroidism 
      necessitating substitution therapy, at latest follow-up 50%, compared to SPX (16% 
      after 3-6 months; none at latest follow-up). Recurrent HPT was common after LSPX, 
      leading to 24 reoperations in 17 patients. No need for substitution therapy after 
      SPX indicated forthcoming recurrent disease. Not having hypocalcemia in the 
      postoperative period and less radical surgery than TPX were significantly 
      associated to risk for recurrence. Further, mutation in exon 3 in the MEN1 gene 
      may eventually be linked to risk of recurrence. CONCLUSION: LSPX is highly 
      associated with recurrence and TPX with continuous hypoparathyroidism, also after 
      long-term follow-up. SPX should be the chosen method in the majority of patients 
      with MEN1 HPT.
FAU - Fyrsten, Ellen
AU  - Fyrsten E
AD  - Department of Surgical Sciences, University Hospital, Uppsala University, 75185, 
      Uppsala, Sweden.
FAU - Norlen, Olov
AU  - Norlen O
AD  - Department of Surgical Sciences, University Hospital, Uppsala University, 75185, 
      Uppsala, Sweden.
FAU - Hessman, Ola
AU  - Hessman O
AD  - Department of Surgical Sciences, University Hospital, Uppsala University, 75185, 
      Uppsala, Sweden.
FAU - Stalberg, Peter
AU  - Stalberg P
AD  - Department of Surgical Sciences, University Hospital, Uppsala University, 75185, 
      Uppsala, Sweden.
FAU - Hellman, Per
AU  - Hellman P
AD  - Department of Surgical Sciences, University Hospital, Uppsala University, 75185, 
      Uppsala, Sweden. per.hellman@surgsci.uu.se.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - World J Surg
JT  - World journal of surgery
JID - 7704052
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Female
MH  - Follow-Up Studies
MH  - *Forecasting
MH  - Humans
MH  - Hyperparathyroidism, Primary/epidemiology/etiology/*therapy
MH  - Hypoparathyroidism/diagnosis/*etiology
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Multiple Endocrine Neoplasia Type 1/*surgery
MH  - Parathyroidectomy/*adverse effects
MH  - *Population Surveillance
MH  - *Postoperative Complications
MH  - Sweden/epidemiology
MH  - Young Adult
EDAT- 2015/11/07 06:00
MHDA- 2016/09/30 06:00
CRDT- 2015/11/07 06:00
PHST- 2015/11/07 06:00 [entrez]
PHST- 2015/11/07 06:00 [pubmed]
PHST- 2016/09/30 06:00 [medline]
AID - 10.1007/s00268-015-3297-9 [pii]
AID - 10.1007/s00268-015-3297-9 [doi]
PST - ppublish
SO  - World J Surg. 2016 Mar;40(3):615-21. doi: 10.1007/s00268-015-3297-9.