PMID- 26542588
OWN - NLM
STAT- MEDLINE
DCOM- 20161025
LR  - 20161230
IS  - 1534-4681 (Electronic)
IS  - 1068-9265 (Linking)
VI  - 23
IP  - 2
DP  - 2016 Feb
TI  - Limited Parathyroidectomy in Multiple Endocrine Neoplasia Type 1-Associated 
      Primary Hyperparathyroidism: A Setup for Failure.
PG  - 416-23
LID - 10.1245/s10434-015-4865-9 [doi]
AB  - BACKGROUND: Recently, some surgeons have suggested that minimally invasive 
      parathyroidectomy guided by preoperative localizing studies of patients with 
      multiple endocrine neoplasia type 1 (MEN1)-associated primary hyperparathyroidism 
      (pHPT) provides an acceptable outcome while minimizing the risk of 
      hypoparathyroidism. This study aimed to evaluate the outcome for MEN1 patients 
      who underwent limited parathyroidectomy compared with subtotal parathyroidectomy. 
      METHODS: The authors performed a retrospective analysis of 99 patients with 
      MEN1-associated pHPT who underwent at least one parathyroid operation at their 
      institution. Preoperative imaging studies, intraoperative findings, and clinical 
      outcomes for patients were compared. RESULTS: A total of 99 patients underwent 
      146 operations. Persistent pHPT was significantly higher in patients whose 
      initial operations involved removal of 1 or 2 glands (69 %) or 2.5 to 3 glands 
      (20 %) compared with those who had 3.5 or more glands removed (6 %) (P < 0.01). 
      Persistent pHPT occurred in 5 % of all operations that cumulatively removed 3.5 
      or more parathyroid glands compared with 40 % of operations that removed 3 or 
      fewer glands (P < 0.01). The single largest parathyroid gland was correctly 
      identified preoperatively in 69 % (22/32) of the patients. However, preoperative 
      localizing studies missed enlarged contralateral parathyroid glands in 86 % 
      (19/22) of these patients. Preoperative localizing studies missed the largest 
      contralateral parathyroid gland in 16 % (5/32) of the patients. CONCLUSIONS: 
      Limited parathyroidectomy in MEN1 is associated with a high failure rate and 
      should not be performed. Preoperative identification of a single enlarged 
      parathyroid gland in MEN1 is not reliable enough to justify unilateral neck 
      exploration because additional enlarged contralateral parathyroid glands are 
      frequently missed.
FAU - Nilubol, Naris
AU  - Nilubol N
AD  - Endocrine Oncology Branch, Center for Cancer Research, National Cancer Institute, 
      National Institutes of Health, Bethesda, MD, USA. niluboln@mail.nih.gov.
FAU - Weinstein, Lee S
AU  - Weinstein LS
AD  - Metabolic Diseases Branch, National Institute of Diabetes and Digestive and 
      Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
FAU - Simonds, William F
AU  - Simonds WF
AD  - Metabolic Diseases Branch, National Institute of Diabetes and Digestive and 
      Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
FAU - Jensen, Robert T
AU  - Jensen RT
AD  - Digestive Diseases Branch, National Institute of Diabetes and Digestive and 
      Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
FAU - Marx, Stephen J
AU  - Marx SJ
AD  - Metabolic Diseases Branch, National Institute of Diabetes and Digestive and 
      Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
FAU - Kebebew, Electron
AU  - Kebebew E
AD  - Endocrine Oncology Branch, Center for Cancer Research, National Cancer Institute, 
      National Institutes of Health, Bethesda, MD, USA.
LA  - eng
GR  - Intramural NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Intramural
DEP - 20151105
PL  - United States
TA  - Ann Surg Oncol
JT  - Annals of surgical oncology
JID - 9420840
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Hyperparathyroidism, Primary/*etiology/pathology
MH  - Male
MH  - Middle Aged
MH  - Multiple Endocrine Neoplasia Type 1/complications/pathology/*surgery
MH  - Neoplasm Staging
MH  - Parathyroidectomy/*adverse effects
MH  - Retrospective Studies
MH  - Treatment Failure
MH  - Young Adult
EDAT- 2015/11/07 06:00
MHDA- 2016/10/26 06:00
CRDT- 2015/11/07 06:00
PHST- 2015/03/03 00:00 [received]
PHST- 2015/11/07 06:00 [entrez]
PHST- 2015/11/07 06:00 [pubmed]
PHST- 2016/10/26 06:00 [medline]
AID - 10.1245/s10434-015-4865-9 [pii]
AID - 10.1245/s10434-015-4865-9 [doi]
PST - ppublish
SO  - Ann Surg Oncol. 2016 Feb;23(2):416-23. doi: 10.1245/s10434-015-4865-9. Epub 2015 
      Nov 5.