Poster Presentation ESA-SRB 2023 in conjunction with ENSA

Less than subtotal parathyroidectomy is an effective surgical approach for multiple endocrine neoplasia type 1–primary hyperparathyroidism (#239)

Jessica Bindra 1 2 3 , Lyndal J Tacon 1 3 , Roderick Clifton-Bligh 1 2 3
  1. Department of Endocrinology, Royal North Shore Hospital, Sydney, NSW, Australia
  2. The Kolling Institute, St Leonards, NSW, Australia
  3. Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

Background: Primary hyperparathyroidism (pHPT) is the most common and usually first endocrinopathy diagnosed in patients with multiple endocrine neoplasia type 1 (MEN1). Less than subtotal parathyroidectomy (LSTP) with selective gland removal can mitigate the risk of developing permanent hypoparathyroidism, which is often seen following total and subtotal parathyroidectomy (STP), while effectively correcting hypercalcaemia.1,2 This retrospective cohort study aims to compare the outcomes of LSTP, STP and total parathyroidectomy in MEN1-associated pHPT. 

Methods: Patients who underwent parathyroidectomy for MEN1-related pHPT were included and informed consent was obtained. Data was extracted from electronic medical records including demographics, type of surgery, length of follow-up, and rates of disease persistence (hyperparathyroidism <6 months), recurrence (hyperparathyroidism >6 months), and hypoparathyroidism.

Results: Ten patients were included with a median age of 39 years (range 16-61), 3 males and 7 females. One patient underwent total parathyroidectomy upfront and developed permanent hypoparathyroidism despite autotransplantation. An additional patient required completion parathyroidectomy and autotransplantation following LSTP due to persistent hyperparathyroidism, and also developed permanent hypoparathyroidism. STP with autotransplantation was the initial surgical choice in one patient and was complicated by permanent hypoparathyroidism. LSTP was the initial surgery in eight (80%) patients, including 2-gland-removal in three patients (37.5%) and 3-gland-removal in five patients (62.5%). LSTP was complicated by persistent disease in two patients and transient hypoparathyroidism in a further two patients, with both cases resolving within 6 months. All cases of disease recurrence occurred in the LSTP group with a rate of 30% and a median time to recurrence of 52 months (range 15-56). 

Conclusion: This single-institution retrospective study describes LSTP as an effective method for managing MEN1-related pHPT, with no reported cases of permanent hypoparathyroidism. Though disease recurrence occurred in 30%, the median time to recurrence was close to 4.5 years, making it an appealing option for younger patients.

  1. Prichard RS, O’Neill CJ, Oucharek JJ, Sippel RS, Delbridge LW, Sidhu SB, et al. Is focused minimally invasive parathyroidectomy appropriate for patients with familial primary hyperparathyroidism? Ann Surg Oncol 2012;19:1264-8.
  2. Versnick M, Popadich A, Sidhu S, Sywak M, Robinson B, Delbridge L. Minimally invasive parathyroidectomy provides a conservative surgical option for multiple endocrine neoplasia type 1-primary hyperparathyroidism. Surgery. 2013 Jul;154(1):101-5.