PMID- 7903001
OWN - NLM
STAT- MEDLINE
DCOM- 19940107
LR  - 20100324
IS  - 0039-6060 (Print)
IS  - 0039-6060 (Linking)
VI  - 114
IP  - 6
DP  - 1993 Dec
TI  - Surgical management of primary hyperparathyroidism in multiple endocrine 
      neoplasia types 1 and 2.
PG  - 1031-7; discussion 1037-9
AB  - BACKGROUND: The surgical management of primary hyperparathyroidism in multiple 
      endocrine neoplasia type 1 (MEN 1) remains controversial. In addition, the rarity 
      of MEN 2A-related hyperparathyroidism has not allowed for a separate strategy for 
      this condition. This study examines our surgical experience with MEN 1- and MEN 
      2A-related hyperparathyroidism and attempts to define a rational therapeutic 
      approach to each. METHODS: Between 1970 and 1991, 124 patients underwent surgery 
      for MEN-related hyperparathyroidism at our institution. Primary cervical 
      explorations were performed in 84 patients with MEN 1 and 18 with MEN 2A. An 
      additional 22 patients with MEN 1 underwent reoperative surgery. All patients 
      with MEN 2A underwent concomitant thyroidectomy for medullary thyroid cancer. 
      RESULTS: Compared with patients with MEN 1, patients with MEN 2A, had a lower 
      preoperative serum Ca2+ level and fewer symptoms or complications of 
      hypercalcemia. Multiple gland disease was evident in 90% and 83%, respectively, 
      of patients with MEN 1 and MEN 2A. Primary explorations in patients with MEN 1 
      resulted in surgical cure in 94%, persistent hypercalcemia occurring in no 
      patient undergoing subtotal resection compared with 17% of patients in whom more 
      conservative resections were performed (p = 0.005). In patients with MEN 1, 
      10-year recurrence of hypercalcemia was 16% for primary explorations and 30% for 
      reoperative procedures. In contrast, all patients with MEN 2A, whether treated by 
      total, subtotal, or lesser resections, were cured after surgery and none had 
      recurrence during a median follow-up of 5.8 years. CONCLUSIONS: In MEN 1 the 
      surgical principles should be (1) identification of all four glands, (2) subtotal 
      resection to ensure cure and facilitate possible reoperation, and (3) excision of 
      supernumerary thymic glands. In MEN 2A we should identify and resect all enlarged 
      glands for cure, but routine subtotal resection need not be performed because 
      this condition is readily cured and recurrence is rare.
FAU - O'Riordain, D S
AU  - O'Riordain DS
AD  - Department of Surgery, Mayo Clinic, Rochester, MN 55905.
FAU - O'Brien, T
AU  - O'Brien T
FAU - Grant, C S
AU  - Grant CS
FAU - Weaver, A
AU  - Weaver A
FAU - Gharib, H
AU  - Gharib H
FAU - van Heerden, J A
AU  - van Heerden JA
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Surgery
JT  - Surgery
JID - 0417347
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Child
MH  - Child, Preschool
MH  - Endocrine Glands/pathology
MH  - Female
MH  - Humans
MH  - Hyperparathyroidism/*etiology/*surgery
MH  - Hypocalcemia/etiology
MH  - Male
MH  - Middle Aged
MH  - Multiple Endocrine Neoplasia/*complications/pathology/surgery
MH  - Neoplasm Recurrence, Local
MH  - Parathyroidectomy
MH  - Postoperative Complications
MH  - Recurrence
MH  - Reoperation
MH  - Treatment Outcome
RF  - 25
EDAT- 1993/12/01 00:00
MHDA- 1993/12/01 00:01
CRDT- 1993/12/01 00:00
PHST- 1993/12/01 00:00 [pubmed]
PHST- 1993/12/01 00:01 [medline]
PHST- 1993/12/01 00:00 [entrez]
AID - 0039-6060(93)90319-9 [pii]
PST - ppublish
SO  - Surgery. 1993 Dec;114(6):1031-7; discussion 1037-9.