Locally recurrent parathyroid neoplasms as a cause for recurrent and persistent primary hyperparathyroidism

Douglas L. Fraker, William D. Travis, John J. Merendino, Mark B. Zimering, Elizabeth A. Streeten, Lee S. Weinstein, Stephen J. Marx, Allen M. Spiegel, Gerald D. Aurbach, John L. Doppman, Jeffrey A. Norton

Research output: Contribution to journalArticle

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Abstract

Between 1982 and 1989, 145 patients underwent operations for persistent or recurrent primary hyperparathyroidism (HPT). At re-exploration, 15 patients (10.3%) were found to have locally recurrent parathyroid tumors (11 patients with adenoma and 4 with carcinoma). These 15 patients had 28 previous operations at outside institutions for HPT. Patients with locally recurrent HPT secondary to adenoma had a longer disease-free interval than patients with locally recurrent carcinoma. At the time of evaluation at the National Institutes of Health (NIH) for recurrent or persistent HPT, each patient was symptomatic and patients with carcinoma had significantly more symptoms and higher serum levels of calcium and parathyroid hormone than patients with adenoma. Locally recurrent parathyroid neoplasm was correctly localized by preoperative testing in 14 of 15 patients. These 15 patients underwent 18 reoperations at NIH for excision of locally recurrent parathyroid tumors. Following the final reoperation (two patients had more than one procedure), each patient had normal serum levels of calcium. In addition each patient remains biochemically cured (based on normal serum calcium level), with a median follow-up interval of 21 months. Local recurrence of parathyroid adenoma comprises a small but significant proportion of cases of recurrent or persistent HPT and can be indistinguishable from parathyroid carcinoma. Findings suggestive of carcinoma include shorter disease-free interval, higher serum levels of calcium and parathyroid hormone, and histologic appearance. Whether the locally recurrent parathyroid neoplasm is benign or malignant, aggressive surgery can control serum levels of calcium in these patients with acceptable rates of morbidity.

Original languageEnglish (US)
Pages (from-to)58-65
Number of pages8
JournalAnnals of Surgery
Volume213
Issue number1
StatePublished - Jan 1991
Externally publishedYes

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Parathyroid Neoplasms
Primary Hyperparathyroidism
Hyperparathyroidism
Calcium
Adenoma
Carcinoma
Serum
National Institutes of Health (U.S.)
Parathyroid Hormone
Reoperation
Secondary Hyperparathyroidism

ASJC Scopus subject areas

  • Surgery

Cite this

Fraker, D. L., Travis, W. D., Merendino, J. J., Zimering, M. B., Streeten, E. A., Weinstein, L. S., ... Norton, J. A. (1991). Locally recurrent parathyroid neoplasms as a cause for recurrent and persistent primary hyperparathyroidism. Annals of Surgery, 213(1), 58-65.

Locally recurrent parathyroid neoplasms as a cause for recurrent and persistent primary hyperparathyroidism. / Fraker, Douglas L.; Travis, William D.; Merendino, John J.; Zimering, Mark B.; Streeten, Elizabeth A.; Weinstein, Lee S.; Marx, Stephen J.; Spiegel, Allen M.; Aurbach, Gerald D.; Doppman, John L.; Norton, Jeffrey A.

In: Annals of Surgery, Vol. 213, No. 1, 01.1991, p. 58-65.

Research output: Contribution to journalArticle

Fraker, DL, Travis, WD, Merendino, JJ, Zimering, MB, Streeten, EA, Weinstein, LS, Marx, SJ, Spiegel, AM, Aurbach, GD, Doppman, JL & Norton, JA 1991, 'Locally recurrent parathyroid neoplasms as a cause for recurrent and persistent primary hyperparathyroidism', Annals of Surgery, vol. 213, no. 1, pp. 58-65.
Fraker DL, Travis WD, Merendino JJ, Zimering MB, Streeten EA, Weinstein LS et al. Locally recurrent parathyroid neoplasms as a cause for recurrent and persistent primary hyperparathyroidism. Annals of Surgery. 1991 Jan;213(1):58-65.
Fraker, Douglas L. ; Travis, William D. ; Merendino, John J. ; Zimering, Mark B. ; Streeten, Elizabeth A. ; Weinstein, Lee S. ; Marx, Stephen J. ; Spiegel, Allen M. ; Aurbach, Gerald D. ; Doppman, John L. ; Norton, Jeffrey A. / Locally recurrent parathyroid neoplasms as a cause for recurrent and persistent primary hyperparathyroidism. In: Annals of Surgery. 1991 ; Vol. 213, No. 1. pp. 58-65.
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