title: Pediatric endocrine surgery: a 20-year experience at the Mayo Clinic.
abstract: BACKGROUND
  Surgically managed endocrinopathies are rare in children. Most surgeons have limited experience in this field. Herein we report our operative experience with pediatric patients, performed over two decades by high-volume endocrine surgeons.
  
  
  METHODS
  The study was conducted at the Mayo Clinic (a tertiary referral center).
  
  
  METHODS
  Patients were <19 years old and underwent an endocrine operation (1993-2012).
  
  
  METHODS
  Demographics, surgical procedure, diagnoses, morbidity, and mortality were retrospectively reviewed.
  
  
  RESULTS
  A total of 241 primary cases included 177 thyroid procedures, 13 neck dissections, 24 parathyroidectomies, 14 adrenalectomies, 7 paragangliomas, and 6 pancreatic procedures. Average age of patients was 14.2 years. There were 133 total thyroidectomies and 40 hemithyroidectomies. Fifty-three cases underwent a central or lateral neck dissection. Six-month follow-up was available for 98 total thyroidectomy patients. There were four cases of permanent hypoparathyroidism (4%) and no permanent recurrent laryngeal nerve (RLN) paralyses. Sequelae of neck dissections included temporary RLN neurapraxia and Horner's syndrome. Parathyroidectomy was performed on 24 patients: 20 with primary hyperparathyroidism (HPT), three with tertiary HPT, and one with familial hypocalciuric hypocalcemia. Three patients (16%) had recurrent HPT, all with multiglandular disease. One patient had temporary RLN neurapraxia. We performed seven bilateral and seven unilateral adrenalectomies; eight were laparoscopic. Indications included pheochromocytoma, Cushing's syndrome, adrenocortical carcinoma, congenital adrenal hyperplasia, and ganglioneuroma. One death was due to adrenocortical carcinoma. Five paraganglioma patients had succinate dehydrogenase subunit B mutations, and one recurred. Six patients with insulinoma underwent enucleation (n = 5) or distal pancreatectomy (n = 1). A single postoperative abscess was managed nonoperatively.
  
  
  CONCLUSIONS
  Pediatric endocrine procedures are uncommon but can be safely performed with complication rates comparable to those of the adult population. It is imperative that these operations be performed by high-volume surgeons.
authors.affiliation: Mayo Clinic, Rochester, Minnesota 55905.
authors.forename: A
authors.initials: A
authors.lastname: Kundel
authors.forename: G B
authors.initials: GB
authors.lastname: Thompson
authors.forename: M L
authors.initials: ML
authors.lastname: Richards
authors.forename: L X
authors.initials: LX
authors.lastname: Qiu
authors.forename: Y
authors.initials: Y
authors.lastname: Cai
authors.forename: F W
authors.initials: FW
authors.lastname: Schwenk
authors.forename: A N
authors.initials: AN
authors.lastname: Lteif
authors.forename: S T
authors.initials: ST
authors.lastname: Pittock
authors.forename: S
authors.initials: S
authors.lastname: Kumar
authors.forename: P J
authors.initials: PJ
authors.lastname: Tebben
authors.forename: I D
authors.initials: ID
authors.lastname: Hay
authors.forename: C S
authors.initials: CS
authors.lastname: Grant
mesh_terms: D000293:Adolescent; D002648:Child; D013507:Endocrine Surgical Procedures / Q000379:methods*; D004700:Endocrine System Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D010372:Pediatrics