التفاصيل البيبلوغرافية
العنوان:
Unilateral Clearance for Primary Hyperparathyroidism in Selected Patients with Multiple Endocrine Neoplasia Type 1
المؤلفون:
Quan-Yang Duh , Toni Beninato , Frederick Thurston Drake , Wouter P. Kluijfhout , Menno R. Vriens , Chienying Liu , Wen T. Shen , Insoo Suh , Jessica E. Gosnell
المصدر:
Kluijfhout, WP; Beninato, T; Drake, FT; Vriens, MR; Gosnell, J; Shen, WT; et al.(2016). Unilateral Clearance for Primary Hyperparathyroidism in Selected Patients with Multiple Endocrine Neoplasia Type 1. World Journal of Surgery, 40(12), 2964-2969. doi: 10.1007/s00268-016-3624-9. UCSF: Retrieved from: http://www.escholarship.org/uc/item/8dp2v422Test
بيانات النشر:
Springer Nature
مصطلحات موضوعية:
Parathyroidectomy , Adult , Male , Reoperation , Technetium Tc 99m Sestamibi , medicine.medical_specialty , Original Scientific Report , endocrine system diseases , Hypoparathyroidism , medicine.medical_treatment , Urology , 030209 endocrinology & metabolism , Subtotal Parathyroidectomy , 03 medical and health sciences , 0302 clinical medicine , Recurrence , Multiple Endocrine Neoplasia Type 1 , Medicine , Humans , MEN1 , Multiple endocrine neoplasia , Radionuclide Imaging , Aged , Retrospective Studies , Ultrasonography , Hyperparathyroidism , business.industry , General surgery , Patient Selection , Middle Aged , medicine.disease , Hyperparathyroidism, Primary , Thymectomy , 030220 oncology & carcinogenesis , Female , Surgery , Radiopharmaceuticals , business , Primary hyperparathyroidism
الوصف:
© 2016, The Author(s). Background: Primary hyperparathyroidism is the most common manifestation of multiple endocrine neoplasia type 1 (MEN1). Guidelines advocate subtotal parathyroidectomy (STP) or total parathyroidectomy with autotransplantation due to high prevalence of multiglandular disease; however, both are associated with a significant risk of permanent hypoparathyroidism. More accurate imaging and use of intraoperative PTH levels may allow a less extensive initial parathyroidectomy (unilateral clearance, removing both parathyroids with cervical thymectomy) in selected MEN1 patients with primary hyperparathyroidism. Methods: We performed a retrospective cohort study at a high-volume tertiary medical center including patients with MEN1 and primary hyperparathyroidism, who underwent STP or unilateral clearance as their initial surgery from 1995 to 2015. Unilateral clearance was offered to patients who had concordant sestamibi and ultrasound showing a single enlarged parathyroid gland. For both the groups, we compared rates of persistent/recurrent disease and permanent hypoparathyroidism. Results: Eight patients had unilateral clearance and 16 had STP. Subtotal parathyroidectomy patients were younger (37 vs 52 years). One patient in each group had persistent disease. One (13 %) unilateral clearance and five (31 %) STP patients had recurrent hyperparathyroidism after a mean follow-up of 47 and 68 months (p = 0.62). No unilateral clearance patients and two of 16 SPT patients had permanent hypoparathyroidism (p = 0.54). Conclusions: Some MEN1 patients with primary hyperparathyroidism who have concordant localizing studies may be selected for unilateral clearance as an alternative to STP. For appropriately selected MEN1 patients, unilateral clearance can achieve similar results as STP and has no risk of permanent hypoparathyroidism, and may facilitate possible future reoperations.
وصف الملف:
application/pdf
اللغة:
English
تدمد:
0364-2313
DOI:
10.1007/s00268-016-3624-9
الوصول الحر:
https://explore.openaire.eu/search/publication?articleId=doi_dedup___::4243a9a0ef86bee28b44645495c45b6fTest
حقوق:
OPEN
رقم الانضمام:
edsair.doi.dedup.....4243a9a0ef86bee28b44645495c45b6f
قاعدة البيانات:
OpenAIRE
