Document Detail


Hyperparathyroidism in multiple endocrine neoplasia type I: surgical trends and results of a 256-patient series from Groupe D'etude des Néoplasies Endocriniennes Multiples Study Group.
MedLine Citation:
PMID:  11572029     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The French and Belgian GENEM study group's multiple endocrine neoplasia type I (MEN-I) database was used to evaluate trends in clinical presentation, surgical treatment of primary hyperparathyroidism (pHPT) (n = 245), and prognostic factors for hypercalcemia correction among 256 MEN-I cases. The patients were retrieved through the GENEM network from various Belgian and French institutions with the help of genetics laboratories. Among the 245 pHPT patients (96%), 42% were men. The mean age at the time of diagnosis was 39.5 +/- 13.3 years. Trends were studied for three periods: before 1986, from 1986 to 1990, and thereafter. After 1990 MEN-I patients were more often diagnosed with isolated pHPT (8%, 11%, 28%, for the three periods, respectively; p = 0.002); it was seen more often in screened patients (31%, 28%, 53%; p = 0.001), more often among those in already known MEN-I families (64%, 45%, 72%; p = 0.005), and among those with lower preoperative calcemia (2.93, 2.87, 2.79 mmol/L; p = 0.001). The age at pHPT diagnosis remained constant throughout the study. The percentage of cervical explorations dropped during the entire study (87%, 87%, 53%; p < 0.0001). After 1985 the percentage of subtotal parathyroidectomies increased (25%, 59%, 51%; p = 0.0004). Pathology disclosed more hyperplasias (59%, 85%, 74%; p = 0.008). Postoperative hypercalcemia decreased (47%, 15%, 19%; p < 0.0001); and postoperative hypocalcemia increased nonsignificantly (5%, 15%, 15%; p = 0.1). Subtotal parathyroidectomy [odds ratio (OR) 13], no MEN-I family background (OR 3), and the most recent study period (> 1985) (OR 3) were significant predictive factors of hypercalcemia correction according to the multivariate analysis. This is the first multicentric study on the management of MEN-I-related pHPT. Immediate postoperative hHPT cure increased, but only 80% of the operated patients were cured after 1990. Fifteen percent were hypocalcemic. Because MEN-I-related hHPT cure remains difficult to achieve, we advocate that subtotal parathyroidectomies be performed in specialized centers.
Authors:
P Goudet; P Cougard; B Vergès; A Murat; B Carnaille; A Calender; J Faivre; C Proye
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  World journal of surgery     Volume:  25     ISSN:  0364-2313     ISO Abbreviation:  World J Surg     Publication Date:  2001 Jul 
Date Detail:
Created Date:  2001-09-26     Completed Date:  2001-12-07     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7704052     Medline TA:  World J Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  886-90     Citation Subset:  IM    
Affiliation:
Service de Chirurgie Viscérale et Urgences, Hôpital Général, 3 Rue du Faubourg-Raines, BP 1519, 21033 Dijon, France. pierre.goudet@chu-dijon.fr
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MeSH Terms
Descriptor/Qualifier:
Adult
Analysis of Variance
Belgium
Diagnostic Techniques, Endocrine / trends*
Endocrine Surgical Procedures / trends*
Female
France
Humans
Hypercalcemia / etiology,  surgery
Hyperparathyroidism / complications,  diagnosis*,  surgery*
Hyperplasia / etiology,  surgery
Male
Middle Aged
Multiple Endocrine Neoplasia Type 1 / complications,  diagnosis*,  surgery*
Odds Ratio
Parathyroid Glands / pathology*,  surgery
Parathyroidectomy
Prognosis
Registries*
Retrospective Studies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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