Total parathyroidectomy in a large cohort of cases with hyperparathyroidism associated with multiple endocrine neoplasia type 1: experience from a single academic center

Detalhes bibliográficos
Autor(a) principal: Montenegro, Fabio Luiz de Menezes
Data de Publicação: 2012
Outros Autores: 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
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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spelling 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
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instname:Universidade de São Paulo (USP)
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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
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