| 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. | |
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MedLine Citation:
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PMID: 11572029 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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P Goudet; P Cougard; B Vergès; A Murat; B Carnaille; A Calender; J Faivre; C Proye |
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Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: World journal of surgery Volume: 25 ISSN: 0364-2313 ISO Abbreviation: World J Surg Publication Date: 2001 Jul |
Date Detail:
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Created Date: 2001-09-26 Completed Date: 2001-12-07 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 7704052 Medline TA: World J Surg Country: United States |
Other Details:
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Languages: eng Pagination: 886-90 Citation Subset: IM |
Affiliation:
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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:
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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 |
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