Abstract
Background
The risk of multiglandular disease (MGD) dictates the extent of exploration in patients with primary hyperparathyroidism (PHPT). Historically, young patients with PHPT were more likely to have MGD, but the existing literature is sparse and conflicting. We hypothesized that young adults (ages 16–40 years) without familial PHPT have a disease process similar to that in older patients.
Methods
A 22-year retrospective chart review was performed on patients who underwent neck exploration for PHPT at our tertiary care center. Altogether, 708 charts were reviewed for demographics, family history, laboratory values, operative findings, pathology, and outcomes.
Results
As a group, young adults comprised 14.0% of the total population and were more likely to have preexisting familial disorders of PHPT (p < 0.01), therapeutic failure (p < 0.01), failure to identify an abnormal parathyroid at operation (p < 0.01), and higher reoperative rates (p = 0.02); they were less likely to have single-gland disease (p = 0.04). Young adults without a family history of the disease demonstrated no disease differences except for a higher rate of symptoms (p < 0.01). Additional analysis found that patients with a family history of hypercalcemia, a sole family member with PHPT, or nephrolithiasis (“possible” family history) were more likely to have MGD (relative risk 2.0).
Conclusions
In this largest single-institution study of young adults with sporadic PHPT, we conclude that sporadic PHPT in young adults represents a disease entity similar to that in older patients, with no increased risk for MGD, and hence they can be managed with a similar surgical approach. Further studies are needed to assess the role of a “possible” family history as a risk factor for MGD.
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References
Doherty GM, Thompson NW (2004) Parathyroid gland. In: Townsend CM (ed) Townsend: Sabiston textbook of surgery, 17th edition. Philadelphia, Aauders
Howe JR (2000) Minimally invasive parathyroid surgery. Surg Clin North Am 80:1399–1426
Sackett WR, Barrclough B, Reeve TS (2002) Worldwide trends in the surgical treatment of primary hyperparathyroidism in the era of minimally invasive parathyroidectomy. Arch Surg 137:1055–1059
Allo M, Thompson NW, Harness JK et al (1982) Primary hyperparathyroidism in children, adolescents, and young adults. World J Surg 6:771–776
Cupisti K, Raffel A, Dotzenrath C et al (2004) Primary hyperparathyroidism in the young age group: particularities of diagnostic and therapeutic schemes. World J Surg 28:1153–1156
Kollars J, Zarroug AE, van Heerden J et al (2005) Primary hyperparathyroidism in pediatric patients. Pediatrics 115:974–980
Hsu SC, Levine MA (2002) Primary hyperparathyroidism in children and adolescents: the Johns Hopkins Children’s Center experience 1984–2001. J Bone Miner Res 17(Suppl 2):N44–N50
Loh KC, Duh QY, Shoback D et al (1998) Clinical profile of primary hyperparathyroidism in adolescents and young adults. Clin Endocrinol (Oxf) 48:435–443
Joshua B, Feinmesser R, Ulanovski D et al (2004) Primary hyperparathyroidism in young adults. Otolaryngol Head Neck Surg 131:628–632
Karges W, Schaaf L, Dralle H et al (2000) Concepts for screening and diagnostic follow-up in multiple endocrine neoplasia type 1 (MEN1). Exp Clin Endocrinol Diabetes 198:334–340
Wermers RA, Khosla S, Atkinson EJ et al (2006) Incidence of primary hyperparathyroidism in Rochester, Minnesota, 1993–2001: an update on the changing epidemiology of the disease. J Bone Miner Res 21:171–177
Wermers RA, Khosla S, Atkinson EJ et al (1997) The rise and fall of primary hyperparathyroidism: a population-based study in Rochester, Minnesota, 1965–1992. Ann Intern Med 126:433–440
Harman CR, van Heerden JA, Farley DR et al (1999) Sporadic primary hyperparathyroidism in young patients: a separate disease entity? Arch Surg 134:651–656
Chesney RW (2005) Primary hyperparathyroidism in pediatric patients: clear-cut differences from adult patients. Pediatrics 115:1073
Cronin CS, Reeve TS, Robinson B et al (1996) Primary hyperparathyroidism in childhood and adolescence. J Paediatr Child Health 32:397–399
Lawson ML, Miller SF, Ellis G et al (1996) Primary hyperparathyroidism in a paediatric hospital. QJM 89:921–932
Mannix HJD (1982) Invited commentary [Response to Primary hyperparathyroidism in children, adolescents, and young adults]. World J Surg 1982;6:775–776
Bai M, Janicic N, Trivedi S et al (1997) In vivo and in vitro characterization of neonatal hyperparathyroidism resulting from a de novo, heterozygous mutation in the Ca2+-sensing receptor gene: normal maternal calcium homeostasis as a cause of secondary hyperparathyroidism in familial benign hypocalciuric hypercalcemia. J Clin Invest 99:1917–1925
Schantz A, Castleman B (1973) Parathyroid carcinoma: a study of 70 cases. Cancer 31:600–605
Makhdoomi KR, Chalmers J, Campbell IW et al (1996) Delayed diagnosis of juvenile primary hyperparathyroidism. J R Coll Surg Edinb 41:351–353
Dimkovic NB, Wallele AA, Oreopoulos DG (2002) Renal stone disease, elevated iPTH level and normocalcemia. Int Urol Nephrol 34:135–141
Carling T, Udelsman R (2005) Parathyroid surgery in familial hyperparathyroid disorders. J Intern Med 257:27–37
Barry MK, van Heerden JA, Grant CS et al (1997) Is familial hyperparathyroidism a unique disease? Surgery 122:1028–1033
Charkes ND (2006) On the prevalence of familial nonmedullary thyroid cancer in multiply affected kindreds. Thyroid 16:181–186
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Adam, L.A., Smith, B.J., Calva-Cerqueira, D. et al. Role for Limited Neck Exploration in Young Adults with Apparently Sporadic Primary Hyperparathyroidism. World J Surg 32, 1518–1524 (2008). https://doi.org/10.1007/s00268-008-9515-y
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DOI: https://doi.org/10.1007/s00268-008-9515-y