title: The outcome of subtotal parathyroidectomy for the treatment of hyperparathyroidism in multiple endocrine neoplasia type 1.
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.
  
  
  METHODS
  Case series and retrospective analysis.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Patients with MEN 1 from 2 families.
  
  
  METHODS
  Subtotal parathyroidectomy, ie, resection of 3 1/2 parathyroid glands from each patient.
  
  
  METHODS
  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.
authors.affiliation: Department of Diabetes and Endocrine Services, Royal Hobart Hospital, Australia. jburges@post.office.utas.edu.au
authors.forename: J R
authors.initials: JR
authors.lastname: Burgess
authors.forename: R
authors.initials: R
authors.lastname: David
authors.forename: V
authors.initials: V
authors.lastname: Parameswaran
authors.forename: T M
authors.initials: TM
authors.lastname: Greenaway
authors.forename: J J
authors.initials: JJ
authors.lastname: Shepherd
mesh_terms: D000328:Adult; D002118:Calcium / Q000097:blood; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood / Q000209:etiology / Q000601:surgery*; D008297:Male; D018761:Multiple Endocrine Neoplasia Type 1 / Q000097:blood / Q000150:complications*; D010282:Parathyroid Neoplasms / Q000097:blood / Q000150:complications*; D016105:Parathyroidectomy / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D002118:Calcium