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Primary and reopera...
Primary and reoperative parathyroid operations in hyperparathyroidism of multiple endocrine neoplasia type 1
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- Hellman, Per (author)
- Uppsala universitet,Endokrinkirurgi
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- Skogseid, Britt (author)
- Uppsala universitet,Medicin
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- Öberg, Kjell (author)
- Uppsala universitet,Medicin
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- Juhlin, Claes (author)
- Uppsala universitet,Endokrinkirurgi
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- Åkerström, Göran (author)
- Uppsala universitet,Endokrinkirurgi
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- Rastad, Jonas (author)
- Uppsala universitet,Endokrinkirurgi
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(creator_code:org_t)
- 1998
- 1998
- English.
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In: Surgery. - 0039-6060 .- 1532-7361. ; 124:6, s. 993-999
- Related links:
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https://urn.kb.se/re...
Abstract
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- Background. Operation and reoperation for hyperparathyroidism in multiple endocrine neoplasia type 1 (MEN 1) is controversial regarding surgical strategy, preoperative localization, and biochemical indexes of recurrence. Methods. Fifty patients with MEN 1 with hyperparathyroidism were followed up 2 to 27 years after subtotal (SPX; n = 35) or total parathyroidectomy with forearm autografiing (TPX; n = 15), including 24 who underwent 28 reoperations because of persistent or recurrent hyperparathyroidism. Results. Persistent or recurrent hyperparathyroidism was seen in 66% and 20% of patients after SPX involving extirpation of at least 3 glands and TPX, respectively, and 100% after single-gland excision as a primary procedure. After reoperation, hypercalcemia was reversed in 33% of patients by SPX and 61% by intended TPX procedures. All patients received vitamin D substitution after TPX, but restricted thyroid function allowed withdrawal in all but 10 patients (36%). Intact serum parathyroid hormone levels in nongrafted and grafted arms rose with time, but only exceptional ratios localized graft recurrence. Localization of recurrent hyperparathyroidism was achieved with 11 C-labeled methionine positron emission tomography. Conclusion. MEN 1 hyperparathyroidism has a high risk of recurrence, and operation may include primarily SPX of at least 3 glands or TPX, although the latter includes a higher risk of long-term hypoparathyroidism. Reoperation should involve TPX with recognition of the enhanced recurrence rate in individuals with postoperative hyperparathyroidism.
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