PMID- 27402205
OWN - NLM
STAT- MEDLINE
DCOM- 20171020
LR  - 20190318
IS  - 1432-2323 (Electronic)
IS  - 0364-2313 (Print)
IS  - 0364-2313 (Linking)
VI  - 40
IP  - 12
DP  - 2016 Dec
TI  - Unilateral Clearance for Primary Hyperparathyroidism in Selected Patients with 
      Multiple Endocrine Neoplasia Type 1.
PG  - 2964-2969
LID - 10.1007/s00268-016-3624-9 [doi]
AB  - BACKGROUND: Primary hyperparathyroidism is the most common manifestation of 
      multiple endocrine neoplasia type 1 (MEN1). Guidelines advocate subtotal 
      parathyroidectomy (STP) or total parathyroidectomy with autotransplantation due 
      to high prevalence of multiglandular disease; however, both are associated with a 
      significant risk of permanent hypoparathyroidism. More accurate imaging and use 
      of intraoperative PTH levels may allow a less extensive initial parathyroidectomy 
      (unilateral clearance, removing both parathyroids with cervical thymectomy) in 
      selected MEN1 patients with primary hyperparathyroidism. METHODS: We performed a 
      retrospective cohort study at a high-volume tertiary medical center including 
      patients with MEN1 and primary hyperparathyroidism, who underwent STP or 
      unilateral clearance as their initial surgery from 1995 to 2015. Unilateral 
      clearance was offered to patients who had concordant sestamibi and ultrasound 
      showing a single enlarged parathyroid gland. For both the groups, we compared 
      rates of persistent/recurrent disease and permanent hypoparathyroidism. RESULTS: 
      Eight patients had unilateral clearance and 16 had STP. Subtotal 
      parathyroidectomy patients were younger (37 vs 52 years). One patient in each 
      group had persistent disease. One (13 %) unilateral clearance and five (31 %) STP 
      patients had recurrent hyperparathyroidism after a mean follow-up of 47 and 
      68 months (p = 0.62). No unilateral clearance patients and two of 16 SPT patients 
      had permanent hypoparathyroidism (p = 0.54). CONCLUSIONS: Some MEN1 patients with 
      primary hyperparathyroidism who have concordant localizing studies may be 
      selected for unilateral clearance as an alternative to STP. For appropriately 
      selected MEN1 patients, unilateral clearance can achieve similar results as STP 
      and has no risk of permanent hypoparathyroidism, and may facilitate possible 
      future reoperations.
FAU - Kluijfhout, Wouter P
AU  - Kluijfhout WP
AD  - Department of Surgery, University of California, Mt Zion, 1600 Divisadero Street, 
      San Francisco, CA, 94115, USA. wpkluijfhout@gmail.com.
AD  - Department of Surgery, University Medical Center Utrecht, Utrecht, The 
      Netherlands. wpkluijfhout@gmail.com.
FAU - Beninato, Toni
AU  - Beninato T
AD  - Department of Surgery, University of California, Mt Zion, 1600 Divisadero Street, 
      San Francisco, CA, 94115, USA.
FAU - Drake, Frederick Thurston
AU  - Drake FT
AD  - Department of Surgery, University of California, Mt Zion, 1600 Divisadero Street, 
      San Francisco, CA, 94115, USA.
FAU - Vriens, Menno R
AU  - Vriens MR
AD  - Department of Surgery, University Medical Center Utrecht, Utrecht, The 
      Netherlands.
FAU - Gosnell, Jessica
AU  - Gosnell J
AD  - Department of Surgery, University of California, Mt Zion, 1600 Divisadero Street, 
      San Francisco, CA, 94115, USA.
FAU - Shen, Wen T
AU  - Shen WT
AD  - Department of Surgery, University of California, Mt Zion, 1600 Divisadero Street, 
      San Francisco, CA, 94115, USA.
FAU - Suh, Insoo
AU  - Suh I
AD  - Department of Surgery, University of California, Mt Zion, 1600 Divisadero Street, 
      San Francisco, CA, 94115, USA.
FAU - Liu, Chienying
AU  - Liu C
AD  - Division of Endocrinology, University of California, San Francisco, CA, USA.
FAU - Duh, Quan-Yang
AU  - Duh QY
AD  - Department of Surgery, University of California, Mt Zion, 1600 Divisadero Street, 
      San Francisco, CA, 94115, USA.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - World J Surg
JT  - World journal of surgery
JID - 7704052
RN  - 0 (Radiopharmaceuticals)
RN  - 971Z4W1S09 (Technetium Tc 99m Sestamibi)
SB  - IM
CIN - World J Surg. 2017 Jan;41(1):328. PMID: 27646283
CIN - World J Surg. 2017 Jan;41(1):329. PMID: 27847968
MH  - Adult
MH  - Aged
MH  - Female
MH  - Humans
MH  - Hyperparathyroidism, Primary/*diagnostic imaging/etiology/*surgery
MH  - Hypoparathyroidism/etiology
MH  - Male
MH  - Middle Aged
MH  - Multiple Endocrine Neoplasia Type 1/complications/*diagnostic imaging/*surgery
MH  - Parathyroidectomy/adverse effects/*methods
MH  - Patient Selection
MH  - Radionuclide Imaging
MH  - Radiopharmaceuticals
MH  - Recurrence
MH  - Reoperation
MH  - Retrospective Studies
MH  - Technetium Tc 99m Sestamibi
MH  - Thymectomy
MH  - Ultrasonography
PMC - PMC5104782
COIS- The authors state that they do not have any conflicts of interest
EDAT- 2016/07/13 06:00
MHDA- 2017/10/21 06:00
PMCR- 2016/07/11
CRDT- 2016/07/13 06:00
PHST- 2016/07/13 06:00 [pubmed]
PHST- 2017/10/21 06:00 [medline]
PHST- 2016/07/13 06:00 [entrez]
PHST- 2016/07/11 00:00 [pmc-release]
AID - 10.1007/s00268-016-3624-9 [pii]
AID - 3624 [pii]
AID - 10.1007/s00268-016-3624-9 [doi]
PST - ppublish
SO  - World J Surg. 2016 Dec;40(12):2964-2969. doi: 10.1007/s00268-016-3624-9.