title: Operative failure rate and documentation of family history in young patients undergoing focused parathyroidectomy for primary hyperparathyroidism.
abstract: Primary hyperparathyroidism in multiple endocrine neoplasia type I usually affects all parathyroid glands, making focused parathyroidectomy (FP) inappropriate. The risk of previously undiagnosed multiple endocrine neoplasia type I in a younger patient with primary hyperparathyroidism is higher than in an older patient. We hypothesized that FP may lead to a higher failure rate in younger versus older patients. A retrospective review was performed of a single-institution database of patients who underwent parathyroidectomy for primary hyperparathyroidism. Routine statistical analysis was performed, including Fisher's exact test. A total of 635 patients were included. Operative failure occurred in 7/55 (13%) younger patients and 21/580 (4%) older patients (P = 0.007). In conclusion, operative failure occurred in a statistically significantly higher percentage of younger versus older patients undergoing FP. This is partly explained by undiagnosed multiple endocrine neoplasia syndrome type I in the younger patient group. Endocrine surgeons must make every effort to preoperatively identify multiple endocrine neoplasia syndrome type I in the younger patient population.
authors.affiliation: Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA.
authors.forename: Elsa T
authors.initials: ET
authors.lastname: Stephen
authors.forename: Amy R
authors.initials: AR
authors.lastname: Quillo
authors.forename: Kelsey E
authors.initials: KE
authors.lastname: Lewis
authors.forename: Farrah L
authors.initials: FL
authors.lastname: Harden
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Bumpous
authors.forename: Michael B
authors.initials: MB
authors.lastname: Flynn
authors.forename: Glenda G
authors.initials: GG
authors.lastname: Callender
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005192:Family Health; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018761:Multiple Endocrine Neoplasia Type 1 / Q000150:complications* / Q000175:diagnosis / Q000235:genetics; D016105:Parathyroidectomy / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D017211:Treatment Failure; D055815:Young Adult