PMID- 9854574
OWN - NLM
STAT- MEDLINE
DCOM- 19990111
LR  - 20171207
IS  - 0039-6060 (Print)
IS  - 0039-6060 (Linking)
VI  - 124
IP  - 6
DP  - 1998 Dec
TI  - Primary and reoperative parathyroid operations in hyperparathyroidism of multiple 
      endocrine neoplasia type 1.
PG  - 993-9
AB  - BACKGROUND: Operation and reoperation for hyperparathyroidism in multiple 
      endocrine neoplasia type 1 (MEN 1) is controversial regarding surgical strategy, 
      preoperative localization, and biochemical indexes of recurrence. METHODS: Fifty 
      patients with MEN 1 with hyperparathyroidism were followed up 2 to 27 years after 
      subtotal (SPX; n = 35) or total parathyroidectomy with forearm autografiing (TPX; 
      n = 15), including 24 who underwent 28 reoperations because of persistent or 
      recurrent hyperparathyroidism. RESULTS: Persistent or recurrent 
      hyperparathyroidism was seen in 66% and 20% of patients after SPX involving 
      extirpation of at least 3 glands and TPX, respectively, and 100% after 
      single-gland excision as a primary procedure. After reoperation, hypercalcemia 
      was reversed in 33% of patients by SPX and 61% by intended TPX procedures. All 
      patients received vitamin D substitution after TPX, but restricted thyroid 
      function allowed withdrawal in all but 10 patients (36%). Intact serum 
      parathyroid hormone levels in nongrafted and grafted arms rose with time, but 
      only exceptional ratios localized graft recurrence. Localization of recurrent 
      hyperparathyroidism was achieved with 11C-labeled methionine positron emission 
      tomography. CONCLUSION: MEN 1 hyperparathyroidism has a high risk of recurrence, 
      and operation may include primarily SPX of at least 3 glands or TPX, although the 
      latter includes a higher risk of long-term hypoparathyroidism. Reoperation should 
      involve TPX with recognition of the enhanced recurrence rate in individuals with 
      postoperative hyperparathyroidism.
FAU - Hellman, P
AU  - Hellman P
AD  - Department of Surgery, University Hospital, Uppsala, Sweden.
FAU - Skogseid, B
AU  - Skogseid B
FAU - Oberg, K
AU  - Oberg K
FAU - Juhlin, C
AU  - Juhlin C
FAU - Akerstrom, G
AU  - Akerstrom G
FAU - Rastad, J
AU  - Rastad J
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Surgery
JT  - Surgery
JID - 0417347
RN  - SY7Q814VUP (Calcium)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Calcium/blood
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Hyperparathyroidism/blood/etiology/*surgery
MH  - Male
MH  - Middle Aged
MH  - Multiple Endocrine Neoplasia Type 1/blood/*complications
MH  - Reoperation
MH  - Treatment Outcome
EDAT- 1998/12/17 00:00
MHDA- 1998/12/17 00:01
CRDT- 1998/12/17 00:00
PHST- 1998/12/17 00:00 [pubmed]
PHST- 1998/12/17 00:01 [medline]
PHST- 1998/12/17 00:00 [entrez]
AID - S0039-6060(98)70040-6 [pii]
PST - ppublish
SO  - Surgery. 1998 Dec;124(6):993-9.