title: Is focused minimally invasive parathyroidectomy appropriate for patients with familial primary hyperparathyroidism?
abstract: BACKGROUND
  The aim of this study was to determine whether a focused minimally invasive parathyroidectomy (MIP) for patients with primary hyperparathyroidism and concordant pre-operative localization studies is appropriate for patients with a family history of the disease. Familial hyperparathyroidism may be seen as a chronic disease in which recurrence is inevitable. Patients frequently undergo subtotal or total parathyroidectomy for perceived 4-gland parathyroid hyperplasia in an attempt to reduce this risk. Controversy remains regarding whether a MIP is appropriate in this setting.
  
  
  METHODS
  Patients undergoing an MIP were identified from prospectively maintained databases. Chart review confirmed the presence of a family history of hyperparathyroidism in a direct relative. Patients with and without a family history were compared regarding overall complications, recurrence, and cure rates.
  
  
  RESULTS
  A total of 1,652 patients underwent a MIP. Of these, 34 patients had a positive family history. There was no statistically significant difference in age, gender, preoperative biochemistry, gland weight, or complication rates between the groups. The cure rate at 6 months from a single operation was equivalent between the 2 groups (97 vs. 98%). With a median of 39 months follow-up, the recurrence rate was higher in those with a family history compared with those without (8.8 vs 1.1%; P=0.002). Reoperation was successful in the small population of familial patients who did present with recurrent hyperparathyroidism.
  
  
  CONCLUSIONS
  The vast majority of patients who underwent a MIP were surgically cured. Although recurrence rates remain higher in the familial hyperparathyroidism group, these data suggest that this alone should not be a contraindication to MIP.
authors: University of Sydney Endocrine Surgical Unit, Sydney, Australia.
authors: Ruth S
authors: RS
authors: Prichard
authors: Christine J
authors: CJ
authors: O'Neill
authors: Jennifer J
authors: JJ
authors: Oucharek
authors: Rebecca S
authors: RS
authors: Sippel
authors: Leigh W
authors: LW
authors: Delbridge
authors: Stanley B
authors: SB
authors: Sidhu
authors: Herbert
authors: H
authors: Chen
mesh_terms: D000328:Adult; D000368:Aged; D002118:Calcium / Q000097:blood; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000235:genetics / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009929:Organ Size; D010280:Parathyroid Glands / Q000473:pathology; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010281:Parathyroid Hormone; D002118:Calcium