Total parathyroidectomy in a large cohort of cases with hyperparathyroidism associated with multiple endocrine neoplasia type 1: experience from a single academic center
Autor(a) principal: | |
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Data de Publicação: | 2012 |
Outros Autores: | , , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Clinics |
Texto Completo: | https://www.revistas.usp.br/clinics/article/view/19733 |
Resumo: | Most cases of sporadic primary hyperparathyroidism present disturbances in a single parathyroid gland and the surgery of choice is adenomectomy. Conversely, hyperparathyroidism associated with multiple endocrine neoplasia type 1 (hyperparathyroidism/multiple endocrine neoplasia type 1) is an asynchronic, asymmetrical multiglandular disease and it is surgically approached by either subtotal parathyroidectomy or total parathyroidectomy followed by parathyroid auto-implant to the forearm. In skilful hands, the efficacy of both approaches is similar and both should be complemented by prophylactic thymectomy. In a single academic center, 83 cases of hyperparathyroidism/ multiple endocrine neoplasia type 1 were operated on from 1987 to 2010 and our first surgical choice was total parathyroidectomy followed by parathyroid auto-implant to the non-dominant forearm and, since 1997, associated transcervical thymectomy to prevent thymic carcinoid. Overall, 40% of patients were given calcium replacement (mean intake 1.6 g/day) during the first months after surgery, and this fell to 28% in patients with longer follow-up. These findings indicate that several months may be needed in order to achieve a proper secretion by the parathyroid auto-implant. Hyperparathyroidism recurrence was observed in up to 15% of cases several years after the initial surgery. Thus, long-term follow-up is recommended for such cases. We conclude that, despite a tendency to subtotal parathyroidectomy worldwide, total parathyroidectomy followed by parathyroid auto-implant is a valid surgical option to treat hyperparathyroidism/multiple endocrine neoplasia type 1. Larger comparative systematic studies are needed to define the best surgical approach to hyperparathyroidism/multiple endocrine neoplasia type 1. |
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Total parathyroidectomy in a large cohort of cases with hyperparathyroidism associated with multiple endocrine neoplasia type 1: experience from a single academic centerHyperparathyroidismParathyroidectomyMEN1Parathyroid glandsParathyroid neoplasmsHypercalcemiaMost cases of sporadic primary hyperparathyroidism present disturbances in a single parathyroid gland and the surgery of choice is adenomectomy. Conversely, hyperparathyroidism associated with multiple endocrine neoplasia type 1 (hyperparathyroidism/multiple endocrine neoplasia type 1) is an asynchronic, asymmetrical multiglandular disease and it is surgically approached by either subtotal parathyroidectomy or total parathyroidectomy followed by parathyroid auto-implant to the forearm. In skilful hands, the efficacy of both approaches is similar and both should be complemented by prophylactic thymectomy. In a single academic center, 83 cases of hyperparathyroidism/ multiple endocrine neoplasia type 1 were operated on from 1987 to 2010 and our first surgical choice was total parathyroidectomy followed by parathyroid auto-implant to the non-dominant forearm and, since 1997, associated transcervical thymectomy to prevent thymic carcinoid. Overall, 40% of patients were given calcium replacement (mean intake 1.6 g/day) during the first months after surgery, and this fell to 28% in patients with longer follow-up. These findings indicate that several months may be needed in order to achieve a proper secretion by the parathyroid auto-implant. Hyperparathyroidism recurrence was observed in up to 15% of cases several years after the initial surgery. Thus, long-term follow-up is recommended for such cases. We conclude that, despite a tendency to subtotal parathyroidectomy worldwide, total parathyroidectomy followed by parathyroid auto-implant is a valid surgical option to treat hyperparathyroidism/multiple endocrine neoplasia type 1. Larger comparative systematic studies are needed to define the best surgical approach to hyperparathyroidism/multiple endocrine neoplasia type 1.Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo2012-01-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://www.revistas.usp.br/clinics/article/view/1973310.6061/clinics/2012(Sup01)22Clinics; Vol. 67 No. supl.1 (2012); 131-139Clinics; v. 67 n. supl.1 (2012); 131-139Clinics; Vol. 67 Núm. supl.1 (2012); 131-1391980-53221807-5932reponame:Clinicsinstname:Universidade de São Paulo (USP)instacron:USPenghttps://www.revistas.usp.br/clinics/article/view/19733/21797Montenegro, Fabio Luiz de MenezesLourenço Junior, Delmar MunizTavares, Marcos RobertoArap, Sergio SamirNascimento Junior, Climerio PereiraMassoni Neto, Ledo MazzeiD'Alessandro, AndréToledo, Rodrigo AlmeidaCoutinho, Flávia LimaBrandão, Lenine GarciaSilva Filho, Gilberto de Britto eCordeiro, Anói CastroToledo, Sergio Pereira Almeidainfo:eu-repo/semantics/openAccess2012-05-24T20:34:46Zoai:revistas.usp.br:article/19733Revistahttps://www.revistas.usp.br/clinicsPUBhttps://www.revistas.usp.br/clinics/oai||clinics@hc.fm.usp.br1980-53221807-5932opendoar:2012-05-24T20:34:46Clinics - Universidade de São Paulo (USP)false |
dc.title.none.fl_str_mv |
Total parathyroidectomy in a large cohort of cases with hyperparathyroidism associated with multiple endocrine neoplasia type 1: experience from a single academic center |
title |
Total parathyroidectomy in a large cohort of cases with hyperparathyroidism associated with multiple endocrine neoplasia type 1: experience from a single academic center |
spellingShingle |
Total parathyroidectomy in a large cohort of cases with hyperparathyroidism associated with multiple endocrine neoplasia type 1: experience from a single academic center Montenegro, Fabio Luiz de Menezes Hyperparathyroidism Parathyroidectomy MEN1 Parathyroid glands Parathyroid neoplasms Hypercalcemia |
title_short |
Total parathyroidectomy in a large cohort of cases with hyperparathyroidism associated with multiple endocrine neoplasia type 1: experience from a single academic center |
title_full |
Total parathyroidectomy in a large cohort of cases with hyperparathyroidism associated with multiple endocrine neoplasia type 1: experience from a single academic center |
title_fullStr |
Total parathyroidectomy in a large cohort of cases with hyperparathyroidism associated with multiple endocrine neoplasia type 1: experience from a single academic center |
title_full_unstemmed |
Total parathyroidectomy in a large cohort of cases with hyperparathyroidism associated with multiple endocrine neoplasia type 1: experience from a single academic center |
title_sort |
Total parathyroidectomy in a large cohort of cases with hyperparathyroidism associated with multiple endocrine neoplasia type 1: experience from a single academic center |
author |
Montenegro, Fabio Luiz de Menezes |
author_facet |
Montenegro, Fabio Luiz de Menezes Lourenço Junior, Delmar Muniz Tavares, Marcos Roberto Arap, Sergio Samir Nascimento Junior, Climerio Pereira Massoni Neto, Ledo Mazzei D'Alessandro, André Toledo, Rodrigo Almeida Coutinho, Flávia Lima Brandão, Lenine Garcia Silva Filho, Gilberto de Britto e Cordeiro, Anói Castro Toledo, Sergio Pereira Almeida |
author_role |
author |
author2 |
Lourenço Junior, Delmar Muniz Tavares, Marcos Roberto Arap, Sergio Samir Nascimento Junior, Climerio Pereira Massoni Neto, Ledo Mazzei D'Alessandro, André Toledo, Rodrigo Almeida Coutinho, Flávia Lima Brandão, Lenine Garcia Silva Filho, Gilberto de Britto e Cordeiro, Anói Castro Toledo, Sergio Pereira Almeida |
author2_role |
author author author author author author author author author author author author |
dc.contributor.author.fl_str_mv |
Montenegro, Fabio Luiz de Menezes Lourenço Junior, Delmar Muniz Tavares, Marcos Roberto Arap, Sergio Samir Nascimento Junior, Climerio Pereira Massoni Neto, Ledo Mazzei D'Alessandro, André Toledo, Rodrigo Almeida Coutinho, Flávia Lima Brandão, Lenine Garcia Silva Filho, Gilberto de Britto e Cordeiro, Anói Castro Toledo, Sergio Pereira Almeida |
dc.subject.por.fl_str_mv |
Hyperparathyroidism Parathyroidectomy MEN1 Parathyroid glands Parathyroid neoplasms Hypercalcemia |
topic |
Hyperparathyroidism Parathyroidectomy MEN1 Parathyroid glands Parathyroid neoplasms Hypercalcemia |
description |
Most cases of sporadic primary hyperparathyroidism present disturbances in a single parathyroid gland and the surgery of choice is adenomectomy. Conversely, hyperparathyroidism associated with multiple endocrine neoplasia type 1 (hyperparathyroidism/multiple endocrine neoplasia type 1) is an asynchronic, asymmetrical multiglandular disease and it is surgically approached by either subtotal parathyroidectomy or total parathyroidectomy followed by parathyroid auto-implant to the forearm. In skilful hands, the efficacy of both approaches is similar and both should be complemented by prophylactic thymectomy. In a single academic center, 83 cases of hyperparathyroidism/ multiple endocrine neoplasia type 1 were operated on from 1987 to 2010 and our first surgical choice was total parathyroidectomy followed by parathyroid auto-implant to the non-dominant forearm and, since 1997, associated transcervical thymectomy to prevent thymic carcinoid. Overall, 40% of patients were given calcium replacement (mean intake 1.6 g/day) during the first months after surgery, and this fell to 28% in patients with longer follow-up. These findings indicate that several months may be needed in order to achieve a proper secretion by the parathyroid auto-implant. Hyperparathyroidism recurrence was observed in up to 15% of cases several years after the initial surgery. Thus, long-term follow-up is recommended for such cases. We conclude that, despite a tendency to subtotal parathyroidectomy worldwide, total parathyroidectomy followed by parathyroid auto-implant is a valid surgical option to treat hyperparathyroidism/multiple endocrine neoplasia type 1. Larger comparative systematic studies are needed to define the best surgical approach to hyperparathyroidism/multiple endocrine neoplasia type 1. |
publishDate |
2012 |
dc.date.none.fl_str_mv |
2012-01-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://www.revistas.usp.br/clinics/article/view/19733 10.6061/clinics/2012(Sup01)22 |
url |
https://www.revistas.usp.br/clinics/article/view/19733 |
identifier_str_mv |
10.6061/clinics/2012(Sup01)22 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
https://www.revistas.usp.br/clinics/article/view/19733/21797 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo |
publisher.none.fl_str_mv |
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo |
dc.source.none.fl_str_mv |
Clinics; Vol. 67 No. supl.1 (2012); 131-139 Clinics; v. 67 n. supl.1 (2012); 131-139 Clinics; Vol. 67 Núm. supl.1 (2012); 131-139 1980-5322 1807-5932 reponame:Clinics instname:Universidade de São Paulo (USP) instacron:USP |
instname_str |
Universidade de São Paulo (USP) |
instacron_str |
USP |
institution |
USP |
reponame_str |
Clinics |
collection |
Clinics |
repository.name.fl_str_mv |
Clinics - Universidade de São Paulo (USP) |
repository.mail.fl_str_mv |
||clinics@hc.fm.usp.br |
_version_ |
1800222758311821312 |