Results of initial operation for hyperparathyroidism in patients with multiple endocrine neoplasia type 1

Dina M. Elaraj, Monica C. Skarulis, Steven K. Libutti, Jeffrey A. Norton, David L. Bartlett, James F. Pingpank, Fathia Gibril, Lee S. Weinstein, Robert T. Jensen, Stephen J. Marx, H. Richard Alexander, Terry C. Lairmore, Irving B. Rosen, Ashok R. Shaha, Henning Dralle, Richard A. Prinz, Collin J. Weber

Research output: Contribution to journalArticle

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Abstract

Background. Hyperparathyroidism in patients with multiple endocrine neoplasia type 1 (MEN1) is characterized by multiglandular disease and a propensity for recurrence after parathyroidectomy (PTx). This study analyzes outcomes of a cohort of MEN1 patients undergoing initial PTx at one institution. Methods. Between April 1960 and September 2002, 92 patients with MEN1 underwent initial PTx. Outcomes were analyzed based on extent of parathyroid resection. Results. Fourteen percent had 2.5 or fewer glands resected, 69% had subtotal PTx, and 17% had total PTx (88% with immediate autotransplantation). The initial surgical cure rate was 98%. Excluding 6 patients lost to follow-up, 33% have developed recurrent hyperparathyroidism (in 46% after ≤ 2.5 PTx, in 33% after subtotal, and in 23% after total PTx). Median recurrence-free survival was not statistically significantly different between subtotal versus total PTx, but it was longer for subtotal and total PTx compared with lesser resection (16.5 vs 7.0 years, respectively, P = .03). The incidence of severe hypoparathyroidism was 46% after total versus 26% after subtotal PTx. Conclusions. Subtotal and total PTx result in durable control of MEN1-associated hyperparathyroidism and have longer recurrence-free intervals compared with lesser resection. The high incidence of severe hypoparathyroidism after total PTx suggests that subtotal PTx is the initial operation of choice in this setting.

Original languageEnglish (US)
Pages (from-to)858-865
Number of pages8
JournalSurgery
Volume134
Issue number6
DOIs
StatePublished - Dec 2003
Externally publishedYes

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Multiple Endocrine Neoplasia Type 1
Hyperparathyroidism
Hypoparathyroidism
Recurrence
Parathyroidectomy
Autologous Transplantation
Lost to Follow-Up
Incidence
Outcome Assessment (Health Care)
Survival

ASJC Scopus subject areas

  • Surgery

Cite this

Elaraj, D. M., Skarulis, M. C., Libutti, S. K., Norton, J. A., Bartlett, D. L., Pingpank, J. F., ... Weber, C. J. (2003). Results of initial operation for hyperparathyroidism in patients with multiple endocrine neoplasia type 1. Surgery, 134(6), 858-865. https://doi.org/10.1016/S0039-6060(03)00406-9

Results of initial operation for hyperparathyroidism in patients with multiple endocrine neoplasia type 1. / Elaraj, Dina M.; Skarulis, Monica C.; Libutti, Steven K.; Norton, Jeffrey A.; Bartlett, David L.; Pingpank, James F.; Gibril, Fathia; Weinstein, Lee S.; Jensen, Robert T.; Marx, Stephen J.; Alexander, H. Richard; Lairmore, Terry C.; Rosen, Irving B.; Shaha, Ashok R.; Dralle, Henning; Prinz, Richard A.; Weber, Collin J.

In: Surgery, Vol. 134, No. 6, 12.2003, p. 858-865.

Research output: Contribution to journalArticle

Elaraj, DM, Skarulis, MC, Libutti, SK, Norton, JA, Bartlett, DL, Pingpank, JF, Gibril, F, Weinstein, LS, Jensen, RT, Marx, SJ, Alexander, HR, Lairmore, TC, Rosen, IB, Shaha, AR, Dralle, H, Prinz, RA & Weber, CJ 2003, 'Results of initial operation for hyperparathyroidism in patients with multiple endocrine neoplasia type 1', Surgery, vol. 134, no. 6, pp. 858-865. https://doi.org/10.1016/S0039-6060(03)00406-9
Elaraj DM, Skarulis MC, Libutti SK, Norton JA, Bartlett DL, Pingpank JF et al. Results of initial operation for hyperparathyroidism in patients with multiple endocrine neoplasia type 1. Surgery. 2003 Dec;134(6):858-865. https://doi.org/10.1016/S0039-6060(03)00406-9
Elaraj, Dina M. ; Skarulis, Monica C. ; Libutti, Steven K. ; Norton, Jeffrey A. ; Bartlett, David L. ; Pingpank, James F. ; Gibril, Fathia ; Weinstein, Lee S. ; Jensen, Robert T. ; Marx, Stephen J. ; Alexander, H. Richard ; Lairmore, Terry C. ; Rosen, Irving B. ; Shaha, Ashok R. ; Dralle, Henning ; Prinz, Richard A. ; Weber, Collin J. / Results of initial operation for hyperparathyroidism in patients with multiple endocrine neoplasia type 1. In: Surgery. 2003 ; Vol. 134, No. 6. pp. 858-865.
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abstract = "Background. Hyperparathyroidism in patients with multiple endocrine neoplasia type 1 (MEN1) is characterized by multiglandular disease and a propensity for recurrence after parathyroidectomy (PTx). This study analyzes outcomes of a cohort of MEN1 patients undergoing initial PTx at one institution. Methods. Between April 1960 and September 2002, 92 patients with MEN1 underwent initial PTx. Outcomes were analyzed based on extent of parathyroid resection. Results. Fourteen percent had 2.5 or fewer glands resected, 69{\%} had subtotal PTx, and 17{\%} had total PTx (88{\%} with immediate autotransplantation). The initial surgical cure rate was 98{\%}. Excluding 6 patients lost to follow-up, 33{\%} have developed recurrent hyperparathyroidism (in 46{\%} after ≤ 2.5 PTx, in 33{\%} after subtotal, and in 23{\%} after total PTx). Median recurrence-free survival was not statistically significantly different between subtotal versus total PTx, but it was longer for subtotal and total PTx compared with lesser resection (16.5 vs 7.0 years, respectively, P = .03). The incidence of severe hypoparathyroidism was 46{\%} after total versus 26{\%} after subtotal PTx. Conclusions. Subtotal and total PTx result in durable control of MEN1-associated hyperparathyroidism and have longer recurrence-free intervals compared with lesser resection. The high incidence of severe hypoparathyroidism after total PTx suggests that subtotal PTx is the initial operation of choice in this setting.",
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T1 - Results of initial operation for hyperparathyroidism in patients with multiple endocrine neoplasia type 1

AU - Elaraj, Dina M.

AU - Skarulis, Monica C.

AU - Libutti, Steven K.

AU - Norton, Jeffrey A.

AU - Bartlett, David L.

AU - Pingpank, James F.

AU - Gibril, Fathia

AU - Weinstein, Lee S.

AU - Jensen, Robert T.

AU - Marx, Stephen J.

AU - Alexander, H. Richard

AU - Lairmore, Terry C.

AU - Rosen, Irving B.

AU - Shaha, Ashok R.

AU - Dralle, Henning

AU - Prinz, Richard A.

AU - Weber, Collin J.

PY - 2003/12

Y1 - 2003/12

N2 - Background. Hyperparathyroidism in patients with multiple endocrine neoplasia type 1 (MEN1) is characterized by multiglandular disease and a propensity for recurrence after parathyroidectomy (PTx). This study analyzes outcomes of a cohort of MEN1 patients undergoing initial PTx at one institution. Methods. Between April 1960 and September 2002, 92 patients with MEN1 underwent initial PTx. Outcomes were analyzed based on extent of parathyroid resection. Results. Fourteen percent had 2.5 or fewer glands resected, 69% had subtotal PTx, and 17% had total PTx (88% with immediate autotransplantation). The initial surgical cure rate was 98%. Excluding 6 patients lost to follow-up, 33% have developed recurrent hyperparathyroidism (in 46% after ≤ 2.5 PTx, in 33% after subtotal, and in 23% after total PTx). Median recurrence-free survival was not statistically significantly different between subtotal versus total PTx, but it was longer for subtotal and total PTx compared with lesser resection (16.5 vs 7.0 years, respectively, P = .03). The incidence of severe hypoparathyroidism was 46% after total versus 26% after subtotal PTx. Conclusions. Subtotal and total PTx result in durable control of MEN1-associated hyperparathyroidism and have longer recurrence-free intervals compared with lesser resection. The high incidence of severe hypoparathyroidism after total PTx suggests that subtotal PTx is the initial operation of choice in this setting.

AB - Background. Hyperparathyroidism in patients with multiple endocrine neoplasia type 1 (MEN1) is characterized by multiglandular disease and a propensity for recurrence after parathyroidectomy (PTx). This study analyzes outcomes of a cohort of MEN1 patients undergoing initial PTx at one institution. Methods. Between April 1960 and September 2002, 92 patients with MEN1 underwent initial PTx. Outcomes were analyzed based on extent of parathyroid resection. Results. Fourteen percent had 2.5 or fewer glands resected, 69% had subtotal PTx, and 17% had total PTx (88% with immediate autotransplantation). The initial surgical cure rate was 98%. Excluding 6 patients lost to follow-up, 33% have developed recurrent hyperparathyroidism (in 46% after ≤ 2.5 PTx, in 33% after subtotal, and in 23% after total PTx). Median recurrence-free survival was not statistically significantly different between subtotal versus total PTx, but it was longer for subtotal and total PTx compared with lesser resection (16.5 vs 7.0 years, respectively, P = .03). The incidence of severe hypoparathyroidism was 46% after total versus 26% after subtotal PTx. Conclusions. Subtotal and total PTx result in durable control of MEN1-associated hyperparathyroidism and have longer recurrence-free intervals compared with lesser resection. The high incidence of severe hypoparathyroidism after total PTx suggests that subtotal PTx is the initial operation of choice in this setting.

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