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The Outcome of Subtotal Parathyroidectomy for the Treatment of Hyperparathyroidism in Multiple Endocrine Neoplasia Type 1

Citation

Burgess, JR and David, R and Parameswaran, V and Greenaway, TM and Shepherd, JJ, The Outcome of Subtotal Parathyroidectomy for the Treatment of Hyperparathyroidism in Multiple Endocrine Neoplasia Type 1, Archives of Surgery, 133, (2) pp. 126-129. ISSN 0004-0010 (1998) [Refereed Article]

DOI: doi:10.1001/archsurg.133.2.126

Abstract

Background: The efficacy of subtotal parathyroidectomy for the treatment of hyperparathyroidism in multiple endocrine neoplasia type 1 (MEN 1) is unclear. The long-term outcome and optimal timing of operation remain controversial. Objective: To determine the long-term outcome of parathyroidectomy for primary hyperparathyroidism in the presence of MEN 1. Design: Case series and retrospective analysis. Setting: Tertiary referral center. Patients: Patients with MEN 1 from 2 families. Interventions: Subtotal parathyroidectomy, ie, resection of 3 1/4 parathyroid glands from each patient. Main Outcome Measures: Recurrence of hyperparathyroidism. Results: Thirty-seven patients underwent subtotal parathyroidectomy. Overall, persistent postoperative hypoparathyroidism developed in 24%, normocalcemia was maintained in 46%, and hyperparathyroidism recurred in 30%. However, after adjustment for the duration of follow-up (by using the Kaplan-Meier method), the cumulative recurrence rates for hyperparathyroidism were 15% at 2 years, 23% at 4 years, 55% at 8 years, and 67% after 8 years. Early recurrence of hyperparathyroidism (within 5 years of operation) was less likely to develop in patients in whom ionized calcium levels of 1.00 mmol/L (4.00 mg/dL) or less were achieved during the perioperative period than in patients in whom this degree of hypocalcemia failed to develop (P=.01). Conclusions: While relatively long periods of disease remission are possible after subtotal parathyroidectomy, our results indicate that recurrent hyperparathyroidism eventually develops in most patients with MEN 1.

Item Details

Item Type:Refereed Article
Research Division:Medical and Health Sciences
Research Group:Paediatrics and Reproductive Medicine
Research Field:Foetal Development and Medicine
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Diabetes
Author:Burgess, JR (Professor John Burgess)
Author:David, R (Mr Reuben David)
Author:Parameswaran, V (Associate Professor Venkat Parameswaran)
Author:Greenaway, TM (Dr Tim Greenaway)
Author:Shepherd, JJ (Professor Joseph Shepherd)
ID Code:13234
Year Published:1998
Web of Science® Times Cited:58
Deposited By:Medicine (Discipline)
Deposited On:1998-08-01
Last Modified:2011-08-08
Downloads:0

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