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Preoperative Localizing Studies for Initial Parathyroidectomy in MEN1 Syndrome: Is There Any Benefit?

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Abstract

Background

The objective of the present study was to evaluate the utility of preoperative localizing studies in patients with MEN1 undergoing initial bilateral neck exploration (BNE) and parathyroidectomy for pHPT.

Methods

We performed a retrospective analysis of patients diagnosed with MEN1 who underwent initial parathyroidectomy between December 1993 and December 2010. Results of preoperative localizing studies were compared with intraoperative findings and outcome.

Results

Sixty patients with MEN1 (32 females and 28 males) underwent initial subtotal parathyroidectomy. The median age at the time of surgery was 33 years (range: 13–78 years). Fifty-three patients had one or more positive localizing study results. Neck ultrasonography, sestamibi scan, parathyroid protocol computed tomography scan, and neck and mediastinum magnetic resonance imaging were performed in 93, 91, 32, and 19% of patients, respectively. Fifty-three patients (88%) had cervical thymectomy. Twenty patients had 24 ectopic parathyroid glands; 18 glands were in the thymus (75%). Preoperative localizing studies identified 9 of 24 ectopic parathyroid glands (38%), including 4 ectopic glands outside the thymus in 4 patients (7%); 3 were detected by ultrasonography. There were no supernumerary glands identified on preoperative localizing studies.

Conclusions

In patients with MEN1, preoperative localizing studies identified a subset of ectopic glands (38%). Preoperative localizing studies may alter the operative approach in 7% of patients. Ultrasonography can detect most ectopic parathyroid glands outside thymus. This suggests that routine preoperative localizing studies to identify ectopic and supernumerary enlarged parathyroid glands is not useful in the majority of patients with MEN1 undergoing bilateral neck exploration and subtotal parathyroidectomy with cervical thymectomy.

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Acknowledgments

This study was supported in part by (1) the Intramural Program of The Center for Cancer Research, The National Cancer Institute, and (2) the Intramural Division of The National Institute of Diabetes, Digestive and Kidney Diseases, The National Institutes of Health. The authors are grateful to Craig Cochran, R.N. (Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD) for his dedication to the service and patient care.

Conflict of interest

All authors have no conflict of interest.

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Authors and Affiliations

  1. Endocrine Oncology Section, Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Drive, MSC1201 Rm 3-3940, Bethesda, MD, 20892-1201, USA

    Naris Nilubol, Giao Q. Phan, Marybeth S. Hughes & Electron Kebebew

  2. Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA

    Lee Weinstein, William F. Simonds & Stephen Marx

  3. Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA

    Robert T. Jensen

  4. Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

    Steven K. Libutti

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  1. Naris Nilubol
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  2. Lee Weinstein
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  3. William F. Simonds
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  4. Robert T. Jensen
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  9. Electron Kebebew
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Correspondence to Naris Nilubol.

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Nilubol, N., Weinstein, L., Simonds, W.F. et al. Preoperative Localizing Studies for Initial Parathyroidectomy in MEN1 Syndrome: Is There Any Benefit?. World J Surg 36, 1368–1374 (2012). https://doi.org/10.1007/s00268-012-1451-1

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