PMID- 27464610 OWN - NLM STAT- MEDLINE DCOM- 20180130 LR - 20200225 IS - 1534-4681 (Electronic) IS - 1068-9265 (Print) IS - 1068-9265 (Linking) VI - 23 IP - Suppl 5 DP - 2016 Dec TI - Reoperative Surgery in Patients with Multiple Endocrine Neoplasia Type 1 Associated Primary Hyperparathyroidism. PG - 701-707 AB - BACKGROUND: Persistent/recurrent primary hyperparathyroidism (pHPT) occurs frequently in multiple endocrine neoplasia type 1 (MEN1). We assessed the usefulness of intraoperative PTH (IOPTH) and preoperative localizing studies based on the outcome of patients with MEN1-associated pHPT undergoing reoperative surgery. METHODS: A retrospective analysis identified MEN1 patients with persistent/recurrent pHPT. Patient outcome was defined as postoperative serum calcium and PTH levels (cured, persistent or recurrent) at last follow-up. Positive predictive value (PPV) was calculated for imaging studies and IOPTH. RESULTS: Thirty patients with MEN1-associated recurrent/persistent pHPT underwent 69 reoperative parathyroidectomies. Median follow-up time was 33 months. Persistent pHPT occurred in four (13 %) patients. IOPTH had a 92 % PPV for postoperative eucalcemia. Ultrasound and Tc99m-sestamibi had sensitivities of 100 and 85 % for localizing an enlarged parathyroid gland. However, five (17 %) patients had additional enlarged glands, not visualized preoperatively that were removed after IOPTH did not drop appropriately. Bone mineral density scores did not improve after reoperation (p = 0.60), but the rate of postoperative nephrocalcinosis did (p = 0.046). Patients with pancreatic neuroendocrine tumors had significantly higher rates of persistent/recurrent pHPT compared with those without (40 vs. 0 %, p = 0.021). Intraoperative and delayed parathyroid autotransplantation was performed in nine (30 %) and four (14 %) patients, respectively. CONCLUSIONS: Although preoperative localizing studies are helpful for guiding reoperative strategy in MEN1 with persistent/recurrent pHPT, additional enlarged glands may be missed by conventional imaging. IOPTH should therefore be employed routinely in this setting. Routine cryopreservation should be considered in all patients. Pancreatic manifestation may be associated with earlier recurrence or persistent disease. FAU - Keutgen, Xavier M AU - Keutgen XM AD - Endocrine Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. xavier.keutgen@nih.gov. FAU - Nilubol, Naris AU - Nilubol N AD - Endocrine Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. FAU - Agarwal, Sunita AU - Agarwal S AD - Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA. FAU - Welch, James AU - Welch J AD - Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA. FAU - Cochran, Craig AU - Cochran C AD - Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA. FAU - Marx, Steve 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 - 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 - 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 - ZIA DK043006-40/Intramural NIH HHS/United States GR - ZIA DK075035-01/Intramural NIH HHS/United States PT - Journal Article DEP - 20160727 PL - United States TA - Ann Surg Oncol JT - Annals of surgical oncology JID - 9420840 RN - 0 (Parathyroid Hormone) RN - 971Z4W1S09 (Technetium Tc 99m Sestamibi) RN - SY7Q814VUP (Calcium) SB - IM MH - Adolescent MH - Adult MH - Aged MH - Bone Density MH - Calcium/blood MH - Disease-Free Survival MH - Female MH - Humans MH - Hyperparathyroidism, Primary/diagnostic imaging/etiology/*surgery MH - Intraoperative Period MH - Magnetic Resonance Imaging MH - Male MH - Middle Aged MH - Multiple Endocrine Neoplasia Type 1/complications/diagnostic imaging/genetics/*surgery MH - Neuroendocrine Tumors/*complications MH - Pancreatic Neoplasms/*complications MH - Parathyroid Glands/diagnostic imaging/transplantation MH - Parathyroid Hormone/*blood MH - Parathyroidectomy MH - Postoperative Period MH - Predictive Value of Tests MH - Radionuclide Imaging MH - Recurrence MH - *Reoperation MH - Retrospective Studies MH - Technetium Tc 99m Sestamibi MH - Tomography, X-Ray Computed MH - Transplantation, Autologous MH - Ultrasonography MH - Young Adult PMC - PMC6415766 MID - NIHMS1011555 COIS- DISCLOSURE The authors declare no conflict of interest. EDAT- 2016/07/29 06:00 MHDA- 2018/01/31 06:00 PMCR- 2019/03/13 CRDT- 2016/07/29 06:00 PHST- 2016/03/21 00:00 [received] PHST- 2016/07/29 06:00 [pubmed] PHST- 2018/01/31 06:00 [medline] PHST- 2016/07/29 06:00 [entrez] PHST- 2019/03/13 00:00 [pmc-release] AID - 10.1245/s10434-016-5467-x [pii] AID - 10.1245/s10434-016-5467-x [doi] PST - ppublish SO - Ann Surg Oncol. 2016 Dec;23(Suppl 5):701-707. doi: 10.1245/s10434-016-5467-x. Epub 2016 Jul 27.