title: Reoperation for hyperparathyroidism in multiple endocrine neoplasia type 1.
abstract: BACKGROUND
  Patients with multiple endocrine neoplasia type 1 and hyperparathyroidism often undergo multiple operations because of inadequate initial surgery, presence of supernumerary and ectopic glands, regrowth of remnant glands, or autograft hyperfunction. Management of this patient population is complex.
  
  
  METHODS
  From January 1975 to December 2000 we performed 94 reoperative parathyroidectomies consisting of 79 neck reexplorations, 12 autograft removals, and 3 median sternotomies in 75 patients. Data were gathered by retrospective chart review and follow-up telephone interviews.
  
  
  RESULTS
  Excluding autograft excision, reoperative surgery was successful (normocalcemia longer than 6 months) in 91%; autograft removal was successful in only 58%. With a median follow-up of 59 months, 64% of patients are currently free from hypercalcemia, and this outcome was not influenced by the total number of glands resected. The median time to recurrent hypercalcemia was 125 months. Thirty patients received an autograft after reoperation. The complication rate for all reoperations was 12%, including permanent recurrent laryngeal nerve injury in 2 patients (2.1%).
  
  
  CONCLUSIONS
  Reoperative parathyroidectomy in patients with multiple endocrine neoplasia type 1 was safe and successful in the majority of patients; however, recurrent hyperparathyroidism is likely to develop in most individuals beyond 10 years of follow-up. The total number of glands accounted for after reoperation is not associated with successful outcome.
authors.affiliation: Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
authors.forename: M H
authors.initials: MH
authors.lastname: Kivlen
authors.forename: D L
authors.initials: DL
authors.lastname: Bartlett
authors.forename: S K
authors.initials: SK
authors.lastname: Libutti
authors.forename: M C
authors.initials: MC
authors.lastname: Skarulis
authors.forename: S J
authors.initials: SJ
authors.lastname: Marx
authors.forename: W F
authors.initials: WF
authors.lastname: Simonds
authors.forename: L S
authors.initials: LS
authors.lastname: Weinstein
authors.forename: R T
authors.initials: RT
authors.lastname: Jensen
authors.forename: J A
authors.initials: JA
authors.lastname: McCart
authors.forename: A M
authors.initials: AM
authors.lastname: Naik
authors.forename: K C
authors.initials: KC
authors.lastname: Kranda
authors.forename: M F
authors.initials: MF
authors.lastname: Brennan
authors.forename: J A
authors.initials: JA
authors.lastname: Norton
authors.forename: D L
authors.initials: DL
authors.lastname: Fraker
authors.forename: H R
authors.initials: HR
authors.lastname: Alexander
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D018761:Multiple Endocrine Neoplasia Type 1 / Q000601:surgery*; D010280:Parathyroid Glands / Q000637:transplantation; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D011183:Postoperative Complications; D012086:Reoperation; D014182:Transplantation, Autologous
chemical_list: D010281:Parathyroid Hormone