PMID- 34952716
OWN - NLM
STAT- MEDLINE
DCOM- 20220502
LR  - 20220519
IS  - 1532-7361 (Electronic)
IS  - 0039-6060 (Linking)
VI  - 171
IP  - 5
DP  - 2022 May
TI  - Evaluation of risk factors, long-term outcomes, and immediate and delayed 
      autotransplantation to minimize postsurgical hypoparathyroidism in multiple 
      endocrine neoplasia type 1 (MEN1): A retrospective cohort study.
PG  - 1240-1246
LID - S0039-6060(21)01079-5 [pii]
LID - 10.1016/j.surg.2021.10.046 [doi]
AB  - BACKGROUND: Postoperative hypoparathyroidism from inadequate parathyroid hormone 
      is of concern after multigland resections in multiple endocrine neoplasia type 
      1-related primary hyperparathyroidism. We evaluated risk factors, long-term 
      outcomes, and roles of autotransplantation and cryopreservation in postoperative 
      hypoparathyroidism in multiple endocrine neoplasia type 1. METHODS: Retrospective 
      cohort study of patients with multiple endocrine neoplasia type 1 and 
      parathyroidectomy who were evaluated at MD Anderson from 1990 to 2020. RESULTS: 
      We included 206 patients. Median follow-up after the last operation (index 65%, 
      reoperation 35%) was 8 years. Index parathyroidectomy was subtotal in 47%, less 
      than subtotal in 42%, and total in 12%; hypoparathyroidism was more frequent 
      after total parathyroidectomy. Forty-seven patients (23%) had hypoparathyroidism 
      >/=6 months; odds were significantly higher when cumulative >/=4 glands were resected 
      (odds ratio 6 [2.96-12.24]) or when immediate postoperative parathyroid hormone 
      was <15 pg/mL (odds ratio 13.10 [3.61-47.47]). After median 26 months 
      postoperatively, 30% recovered parathyroid function spontaneously; this was less 
      likely when >/=4 glands were resected (odds ratio 0.19 [0.05-0.72]). None of the 4 
      patients who were aparathyroid (parathyroid hormone undetectable or </=3 pg/mL) at 
      6 months postoperatively recovered parathyroid function. Immediate 
      autotransplantation success rate was 72%. Cryopreservation was performed in 96 
      operations with delayed autotransplantation in 10 patients (10% utilization), of 
      whom 5 recovered parathyroid function (time to recovery 12-93 months). 
      CONCLUSION: Odds of prolonged hypoparathyroidism are higher when cumulative >/=4 
      glands are resected or postoperative parathyroid hormone is <15 pg/mL. 
      Spontaneous recovery occurred but was less likely when >/=4 glands were resected or 
      patients were aparathyroid at 6 months postoperatively. Cryopreservation should 
      be sparingly used, but there is value in select high-risk patients such as 
      reoperative parathyroidectomy/cervical surgery.
CI  - Copyright (c) 2021. Published by Elsevier Inc.
FAU - Landry, Jace P
AU  - Landry JP
AD  - Department of Surgical Oncology, Section of Surgical Endocrinology, University of 
      Texas MD Anderson Cancer Center, Houston, TX.
FAU - Pieterman, Carolina R C
AU  - Pieterman CRC
AD  - Department of Surgical Oncology, Section of Surgical Endocrinology, University of 
      Texas MD Anderson Cancer Center, Houston, TX.
FAU - Clemente-Gutierrez, Uriel
AU  - Clemente-Gutierrez U
AD  - Department of Surgical Oncology, Section of Surgical Endocrinology, University of 
      Texas MD Anderson Cancer Center, Houston, TX.
FAU - Grubbs, Elizabeth G
AU  - Grubbs EG
AD  - Department of Surgical Oncology, Section of Surgical Endocrinology, University of 
      Texas MD Anderson Cancer Center, Houston, TX.
FAU - Fisher, Sarah B
AU  - Fisher SB
AD  - Department of Surgical Oncology, Section of Surgical Endocrinology, University of 
      Texas MD Anderson Cancer Center, Houston, TX.
FAU - Graham, Paul H
AU  - Graham PH
AD  - Department of Surgical Oncology, Section of Surgical Endocrinology, University of 
      Texas MD Anderson Cancer Center, Houston, TX.
FAU - Waguespack, Steven G
AU  - Waguespack SG
AD  - Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas MD 
      Anderson Cancer Center, Houston, TX.
FAU - Perrier, Nancy D
AU  - Perrier ND
AD  - Department of Surgical Oncology, Section of Surgical Endocrinology, University of 
      Texas MD Anderson Cancer Center, Houston, TX. Electronic address: 
      nperrier@mdanderson.org.
LA  - eng
GR  - T32 CA009599/CA/NCI NIH HHS/United States
GR  - P30 CA016672/CA/NCI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20211221
PL  - United States
TA  - Surgery
JT  - Surgery
JID - 0417347
RN  - 0 (Parathyroid Hormone)
SB  - IM
MH  - Humans
MH  - *Hypoparathyroidism/etiology/prevention & control
MH  - *Multiple Endocrine Neoplasia Type 1/complications/surgery
MH  - Neoplasm Recurrence, Local/surgery
MH  - Parathyroid Glands/transplantation
MH  - Parathyroid Hormone
MH  - Parathyroidectomy/adverse effects
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Transplantation, Autologous/adverse effects
EDAT- 2021/12/26 06:00
MHDA- 2022/05/03 06:00
CRDT- 2021/12/25 05:20
PHST- 2021/04/22 00:00 [received]
PHST- 2021/10/12 00:00 [revised]
PHST- 2021/10/21 00:00 [accepted]
PHST- 2021/12/26 06:00 [pubmed]
PHST- 2022/05/03 06:00 [medline]
PHST- 2021/12/25 05:20 [entrez]
AID - S0039-6060(21)01079-5 [pii]
AID - 10.1016/j.surg.2021.10.046 [doi]
PST - ppublish
SO  - Surgery. 2022 May;171(5):1240-1246. doi: 10.1016/j.surg.2021.10.046. Epub 2021 
      Dec 21.