The aim of this study was to determine whether a focused minimally invasive parathyroidectomy (MIP) for patients with primary hyperparathyroidism and concordant pre-operative localization studies is appropriate for patients with a family history of the disease. Familial hyperparathyroidism may be seen as a chronic disease in which recurrence is inevitable. Patients frequently undergo subtotal or total parathyroidectomy for perceived 4-gland parathyroid hyperplasia in an attempt to reduce this risk. Controversy remains regarding whether a MIP is appropriate in this setting.
Patients undergoing an MIP were identified from prospectively maintained databases. Chart review confirmed the presence of a family history of hyperparathyroidism in a direct relative. Patients with and without a family history were compared regarding overall complications, recurrence, and cure rates.
A total of 1,652 patients underwent a MIP. Of these, 34 patients had a positive family history. There was no statistically significant difference in age, gender, preoperative biochemistry, gland weight, or complication rates between the groups. The cure rate at 6 months from a single operation was equivalent between the 2 groups (97 vs. 98%). With a median of 39 months follow-up, the recurrence rate was higher in those with a family history compared with those without (8.8 vs 1.1%; P = 0.002). Reoperation was successful in the small population of familial patients who did present with recurrent hyperparathyroidism.
The vast majority of patients who underwent a MIP were surgically cured. Although recurrence rates remain higher in the familial hyperparathyroidism group, these data suggest that this alone should not be a contraindication to MIP.
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Kebebew E, Clark OH. Parathyroid adenoma, hyperplasia and carcinoma: localization, technical details of primary neck exploration and treatment of hypercalcaemic crisis. Surg Oncol Clin N Am. 1998;7:721–48.
Lew JI, Soloranzo CC. Surgical management of primary hyperparathyroidism: State of the art. Surg Clin N Am. 2009;89:1205–25.
Mack LA, Pasieka JL. Asymptomatic primary hyperparathyroidism: a surgical perspective. Surg Clin N Am. 2004;84:803–16.
Chen H, Mack E, Starling JR. A comprehensive evaluation of peri-operative adjuncts during minimally invasive parathyroidectomy: which is most reliable? Ann Surg. 2005;242:375–83.
Palazzo FF, Delbridge LW. Minimal-access/minimally invasive parathyroidectomy for primary hyperparathyroidism. Surg Clin N Am. 2004;84:717–34.
Irvin GL III, Soloranzo CC, Carneiro DM. Quick intra-operative parathyroid hormone assay: surgical adjunct to allow limited parathyroidectomy, improve success rates and predict outcome. World J Surg. 2004;28:1287–92.
Siperstein A, Berber E, Mackey R. Prospective evaluation of sestamibi scan, ultrasonography and rapid PTH to predict the success of limited exploration for sporadic primary hyperparathyroidism. Surgery. 2004;136:872–80.
Chen H, Pruhs ZM, Starling JR. Intraoperative parathyroid hormone testing improves cure rates in patients undergoing minimally invasive parathyroidectomy. Surgery. 2005;138:583–90.
Grant CS, Thompson G, Farley D. Primary hyperparathyroidism surgical management since the introduction of minimally invasive parathyroidectomy: Mayo clinic experience. Arch Surg. 2005;140:472–8.
Lal A, Bianco J, Chen H. Radioguided parathyroidectomy in patients with familial hyperparathyroidism. Ann Surg Oncol. 2007;14:739–43.
Stalberg P, Carling T. Familial parathyroid tumours: diagnosis and management. World J Surg. 2009;33:2234–43.
Goldman L, Smyth FS. Hyperparathyroidism in sibling. Am Surg. 1936;104:971–81.
Warner JV, Nyholt DR, Busfield F. Familial isolated hyperparathyroidism is linked to a 1.7 Mb regions on chromosome 2p3.314. J Med Genet. 2006;43:e12.
Carling T, Udelsman R. Parathyroid surgery in familial hyperparathyroid disorders. J Inter Med. 2005;257:27–37.
Hellman P, Skogseid B, Oberg K. Primary and re-operative parathyroid operations in hyperparathyroidism of multiple endocrine type 1. Surgery. 1988;124:993–9.
Burgess JR, David R, Parameswaran V. The outcome of subtotal thyroidectomy for the treatment of hyperparathyroidism in multiple endocrine neoplasia type 1. Arch Surg. 1998;133:126–9.
Thompson NW. The surgical management of hyperparathyroidism and endocrine disease of the pancreas in the multiple endocrine neoplasia type 1 patient. J Intern Med. 1995;238:269–80.
Goudet P, Cougard P, Verges B. Hyperparathyroidism in multiple endocrine neoplasia type 1: surgical trends and results of a 256-patient series from Groupe D’Etude des Neoplasies Endocriniennes Multiples Study Group. World J Surg. 2001;25:886–90.
O’Riordain DS, O’Brien T, Grant CS. Surgical management of primary hyperparathyroidism in multiple endocrine neoplasia types 1 and 2. Surgery. 1993;114:1031–7.
Elaraj DM, Skarulis MC, Libutti SK. Results of initial operation for hyperparathyroidism in patients with multiple endocrine neoplasia type 1. Surgery. 2003;134:858–64.
Hubbard JG, Sebag F, Maweja S. Subtotal parathyroidectomy as an adequate treatment for primary hyperparathyroidism in multiple endocrine neoplasia type 1. Arch Surg. 2006;141:235–9.
Tonelli F, Spini S, Tommasi M. Intra-operative parathyroid hormone measurement in patients with multiple endocrine neoplasia type 1 syndrome and hyperparathyroidism. World J Surg. 2000;24:556–62.
Dotzenrath C, Cupisti K, Goretzki PE. Long-term biochemical results after operative treatment of primary hyperparathyroidism associated with multiple endocrine neoplasia type I and IIa: is a more or less extended operation essential. Eur J Surg. 2001;167:173–8.
Kivlen MH, Bartlett DL, Libutti SK. Reoperation for hyperparathyroidism in multiple endocrine neoplasia type 1. Surgery. 2001;130:991–8.
Sharma J, Weber CJ. Surgical therapy for familial hyperparathyroidism. Am Surg. 2009;75:579–83.
Huang SM, Duh QY, Shaver J. Familial hyperparathyroidism without multiple endocrine neoplasia. World J Surg. 1997;21:22–9.
Barry MK, van Heerden JA, Grant CS. Is familial hyperparathyroidism a unique disease? Surgery. 1997;122:1028–33.
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Prichard, R.S., O’Neill, C.J., Oucharek, J.J. et al. Is Focused Minimally Invasive Parathyroidectomy Appropriate for Patients With Familial Primary Hyperparathyroidism?. Ann Surg Oncol 19, 1264–1268 (2012). https://doi.org/10.1245/s10434-011-2092-6
- Positive Family History
- Primary Hyperparathyroidism
- Multiple Endocrine Neoplasia Type
- Parathyroid Carcinoma