Surgical treatment of hyperparathyroidism in patients with multiple endocrine neoplasia type 1.
OBJECTIVE
Three-gland parathyroidectomy with trans-cervical thymectomy and cryopreservation is the preferred initial surgical approach for hyperparathyroidism (HPT) in patients with multiple endocrine neoplasia type 1.


METHODS
Retrospective cohort study.


METHODS
Tertiary referral center.


METHODS
Thirty-seven patients with multiple endocrine neoplasia type 1 who underwent 1 or more surgical procedures for HPT from January 1, 1973 to April 30, 2004.


RESULTS
At initial parathyroid surgery, 16 (43%) of 37 patients had fewer than 3 parathyroid glands resected (group 1); 16 (43%) had at least 3 but fewer than 4 glands (group 2), and 5 (14%), 4 or more glands (group 3). Follow-up of at least 6 months after initial surgery was complete for 31 (84%) of 37 patients.


CONCLUSIONS
Recurrent HPT in patients with multiple endocrine neoplasia type 1 is frequent if fewer than 3 glands are removed at initial parathyroidectomy. Optimal surgical intervention must balance the risk of recurrent hypercalcemia with the morbidity of permanent hypoparathyroidism. Three-gland parathyroidectomy, transcervical thymectomy, and parathyroid cryopreservation constitute our preferred initial surgical procedure.
Lambert
Laura A
LA
Department of Surgical Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, 77230-1402, USA.
Shapiro
Suzanne E
SE
Lee
Jeffrey E
JE
Perrier
Nancy D
ND
Truong
Mylene
M
Wallace
Michael J
MJ
Hoff
Ana O
AO
Gagel
Robert F
RF
Evans
Douglas B
DB
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018761:Multiple Endocrine Neoplasia Type 1 / Q000150:complications*; D016105:Parathyroidectomy; D012189:Retrospective Studies; D016896:Treatment Outcome