RECURRENCE
OF PRIMARY HYPERPARATHYROIDISM (PHPT) FOLLOWING SURGERY IN MEN1 PATIENTS
Recurrent PHPT
is not uncommon in MEN1 syndrome (observed in 20 – 70 % of patients within 8 –
14 years following initial surgery). Reoperation may achieve cure in a high percentage
of these patients (80 – 90 %). Localization of the hyperfunctioning parathyroid
tissue is mandatory prior to reoperation. There are three clinical scenarios:
(A)Recurrence
following subtotal (three and one-half) parathyroidectomy: completion total parathyroidectomy
(removing the remaining part of the [one] preserved parathyroid gland) with
forearm autotransplantation or debulking of the parathyroid remnant is the treatment
of choice
(B)Recurrence
following total parathyroidectomy with forearm autotransplantation: debulking
or excision of the forearm autograft is indicated
(C).
Supernumerary or ectopic hyperplastic gland (in the neck or mediastinum) may
also be the cause of recurrent PHPT in MEN1 patients. Accurate localization of
this gland is necessary to achieve surgical resection of the hyperplastic gland
and cure of the disease.
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