Long-term biochemical results after operative treatment of primary hyperparathyroidism associated with multiple endocrine neoplasia types I and IIa: is a more or less extended operation essential?
OBJECTIVE
To analyse our long term results in patients operated on for primary hyperparathyroidism associated with multiple endocrine neoplasia types I and IIa.


METHODS
Retrospective (data collection) and prospective (follow-up) analysis.


METHODS
University hospital, Germany.


METHODS
39 patients with MEN type I-associated and 7 patients with MEN-type-IIa-associated primary hyperparathyroidism.


METHODS
Subtotal parathyroidectomy (n = 25 with MEN I and 1 with MEN IIa), total parathyroidectomy and autotransplantation (one in each group) and removal of only enlarged glands (13 with MEN type I and 5 with MEN type IIa).


METHODS
Recurrence rate of hyperparathyroidism and permanent hypocalcaemia postoperatively.


RESULTS
Subtotal parathyroidectomy in patients with MEN type I gave a significantly lower recurrence rate than removal of only enlarged glands (3/25 compared with 3/13, log rank, p = 0.04). Permanent hypocalcaemia developed in 3/25 compared with 3/13, respectively. 2/5 patients with MEN type IIa developed recurrences after removal of only enlarged glands and the rate was higher than expected.


CONCLUSIONS
A more extensive operation is essential for patients with MEN type I; the rate of permanent hypocalcaemia is not increased, but the recurrence rate is reduced. Patients with MEN type IIa should be treated by excision of enlarged glands alone, but this may be extended to subtotal parathyroidectomy in patients with severe symptoms.
Dotzenrath
C
C
Department of Surgery, Heinrich Heine University Düsseldorf, Germany.
Cupisti
K
K
Goretzki
P E
PE
Yang
Q
Q
Simon
D
D
Ohmann
C
C
Röher
H D
HD
D000236:Adenoma / Q000150:complications; D007516:Adenoma, Islet Cell / Q000150:complications; D000306:Adrenal Cortex Neoplasms / Q000150:complications; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology; D006961:Hyperparathyroidism / Q000150:complications* / Q000601:surgery*; D006996:Hypocalcemia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D018761:Multiple Endocrine Neoplasia Type 1 / Q000150:complications*; D018813:Multiple Endocrine Neoplasia Type 2a / Q000150:complications*; D010190:Pancreatic Neoplasms / Q000150:complications; D016105:Parathyroidectomy / Q000379:methods*; D010911:Pituitary Neoplasms / Q000150:complications; D012086:Reoperation; D012189:Retrospective Studies; D055502:Secondary Prevention