PMID- 30899245 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200225 IS - 1664-2392 (Print) IS - 1664-2392 (Electronic) IS - 1664-2392 (Linking) VI - 10 DP - 2019 TI - Could the Less-Than Subtotal Parathyroidectomy Be an Option for Treating Young Patients With Multiple Endocrine Neoplasia Type 1-Related Hyperparathyroidism? PG - 123 LID - 10.3389/fendo.2019.00123 [doi] LID - 123 AB - Background: The surgical treatment of primary hyperparathyroidism (HPT) in patients with multiple endocrine neoplasia type 1 (MEN1) has evolved due the concern of permanent hypoparathyroidism. As the diagnosis has increased, the extent of operation has decreased. Most MEN1 patients requiring parathyroidectomy are younger than 50 years and they pose a difficult balance to achieve between persistent HPT and life-long hypoparathyroidism. The aim of the present study is to review our experience with a large series of patients with MEN1-related HPT (HPT/MEN1) treated at a single institution in order to find clues to a better treatment decision in these younger cases. Method: Retrospective analysis of consecutive HPT/MEN1 cases treated at a single institution with different operations: total parathyroidectomy and immediate forearm autograft (TPTX-AG), subtotal (STPTX), unintentional less than subtotal (U-LSTPTX) and intentional less than subtotal parathyroidectomy (I-LSTPTX). Results: Considering 84 initial cases operated on since 2011 (TPTX-AG, 39; STPTX, 22, U-LSTPTX, 13, and I-LSTPTX, 10), the rates of hypoparathyroidism were 30.8% (U-LSTPTX), 28.2% (TPTX-AG), 13.6% (STPTX), and 0% (I-LSTPTX). Two-thirds of them (68%; 57/84) were young (<50 years) or asdolescents. MIBI scan was more sensitive to show parathyroid glands and bilateral disease. Considering the concordance of MIBI and ultrasound for the possibility of unilateral clearance, it would be suitable to 22.6% of the cases. Intra-operative parathormone showed a significant decay even after unilateral exploration, but longer follow up is necessary. Overall, there were seven (4%) adolescents in 161 cases treated from 1987 to 2018, three underwent TPTX-AG and four had U-LSTPTX. Five are euparathyroid, one had mild recurrence, and one required a reoperation after 8 years due to the residual gland. Conclusions: Young patients are the most frequent candidates to parathyroidectomy. Less extensive procedures may be planned only if carefully reviewed preoperative imaging studies suggest a localized disease. Patients and their relatives should be fully informed of the risks and benefits during consent process. Future research with larger cohorts and long-term results are necessary to clarify if less than I-LSPTX or unilateral clearance are really adequate in selected groups of patients with HPT/MEN1 presenting lower volume of disease detected by preoperative imaging studies. FAU - Montenegro, Fabio Luiz de Menezes AU - Montenegro FLM AD - Parathyroid Unit- LIM-28, Laboratorio de Cirurgia de Cabeca e Pescoco, Head and Neck Surgery, Department of Surgery, Hospital das Clinicas HCFMUSP, University of Sao Paulo School of Medicine, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil. FAU - Brescia, Marilia D'Elboux Guimaraes AU - Brescia MDG AD - Parathyroid Unit- LIM-28, Laboratorio de Cirurgia de Cabeca e Pescoco, Head and Neck Surgery, Department of Surgery, Hospital das Clinicas HCFMUSP, University of Sao Paulo School of Medicine, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil. FAU - Lourenco, Delmar Muniz Jr AU - Lourenco DM Jr AD - Endocrine Genetics Unit (LIM-25), Endocrinology Division, Hospital das Clinicas, University of Sao Paulo School of Medicine, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil. AD - Endocrine Oncology Division, Institute of Cancer of the State of Sao Paulo, University of Sao Paulo School of Medicine, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil. FAU - Arap, Sergio Samir AU - Arap SS AD - Parathyroid Unit- LIM-28, Laboratorio de Cirurgia de Cabeca e Pescoco, Head and Neck Surgery, Department of Surgery, Hospital das Clinicas HCFMUSP, University of Sao Paulo School of Medicine, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil. FAU - d'Alessandro, Andre Fernandes AU - d'Alessandro AF AD - Parathyroid Unit- LIM-28, Laboratorio de Cirurgia de Cabeca e Pescoco, Head and Neck Surgery, Department of Surgery, Hospital das Clinicas HCFMUSP, University of Sao Paulo School of Medicine, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil. FAU - de Britto E Silva Filho, Gilberto AU - de Britto E Silva Filho G AD - Parathyroid Unit- LIM-28, Laboratorio de Cirurgia de Cabeca e Pescoco, Head and Neck Surgery, Department of Surgery, Hospital das Clinicas HCFMUSP, University of Sao Paulo School of Medicine, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil. FAU - Toledo, Sergio Pereira de Almeida AU - Toledo SPA AD - Endocrine Genetics Unit (LIM-25), Endocrinology Division, Hospital das Clinicas, University of Sao Paulo School of Medicine, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil. LA - eng PT - Journal Article DEP - 20190307 PL - Switzerland TA - Front Endocrinol (Lausanne) JT - Frontiers in endocrinology JID - 101555782 PMC - PMC6417394 OTO - NOTNLM OT - adolescent OT - calcium OT - hyperparathyroidism OT - hypoparathyroidism OT - multiple endocrine neoplasia type 1 OT - parathormone OT - parathyroidectomy OT - surgery EDAT- 2019/03/23 06:00 MHDA- 2019/03/23 06:01 PMCR- 2019/01/01 CRDT- 2019/03/23 06:00 PHST- 2018/11/15 00:00 [received] PHST- 2019/02/11 00:00 [accepted] PHST- 2019/03/23 06:00 [entrez] PHST- 2019/03/23 06:00 [pubmed] PHST- 2019/03/23 06:01 [medline] PHST- 2019/01/01 00:00 [pmc-release] AID - 10.3389/fendo.2019.00123 [doi] PST - epublish SO - Front Endocrinol (Lausanne). 2019 Mar 7;10:123. doi: 10.3389/fendo.2019.00123. eCollection 2019.