Causes and treatment of recurrent hyperparathyroidism after subtotal parathyroidectomy in the presence of multiple endocrine neoplasia 1.
BACKGROUND
Subtotal parathyroidectomy (SPTX) is the treatment of choice for hyperparathyroidism in a patient with multiple endocrine neoplasia type 1 (HPT-MEN-1). There are scarce data on the causes, timing, and appropriate surgical treatment of patients with recurrent HPT-MEN-1. The aim of this study was to investigate the timing, causes, site of recurrence, and surgical treatment of recurrent HPT-MEN-1 in patients who underwent SPTX.


METHODS
The study was a retrospective review of prospectively collected data on patients with HPT-MEN-1 with SPTX at two referral institutions. The data collected included the following: demographics, duration of follow-up, weight of resected parathyroid tissue, type of remnant, time to reoperation, cause/site of recurrence, and surgical treatment. We studied prognostic factors of recurrence.


RESULTS
A total of 69 patients underwent SPTX and were followed for a mean of 75.3 months. After the surgery, 15 patients were left with a single "normal" gland and 54 with a 50- to 70-mg remnant of a partially excised abnormal gland. Nine patients (13%) had a recurrence within a mean of 85 months (12-144 months). Patients with a recurrence had been followed longer (115 vs. 66 months; p = 0.005). Five recurrences occurred in a parathyroid remnant, 3 in a previously "normal" gland; the fifth recurrence was in both a hyperplastic remnant and a fifth gland. Remedial surgery included five subtotal resections and four immediate parathyroid autotransplantations. Two patients had a second recurrence due to a supernumerary gland. Factors related with recurrence are the follow-up time (p < 0.01) and thymectomy (p < 0.003).


CONCLUSIONS
Recurrence of HPTP-MEN-1 usually is located in preserved parathyroid tissue with no preference for a previously normal gland or a remnant. A second recurrence is most likely seen in a supernumerary gland. Recurrence is associated with the follow-up time and thymectomy.
Salmeron
Maria D Balsalobre
MD
Unit Endocrine Surgery, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
Gonzalez
Jose Manuel Rodriguez
JM
Sancho Insenser
Joan
J
Fornos
Joan Sancho
JS
Goday
Albert
A
Perez
Nuria Maria Torregrosa
NM
Zambudio
Antonio Rios
AR
Paricio
Pascual Parrilla
PP
Serra
Antonio Sitges
AS
D000293:Adolescent; D000328:Adult; D000368:Aged; D002118:Calcium / Q000097:blood; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018761:Multiple Endocrine Neoplasia Type 1 / Q000150:complications* / Q000601:surgery*; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D011379:Prognosis; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
D010281:Parathyroid Hormone; D002118:Calcium