13/09/2018
Interessanter Artikel zum Zeitpunkt der Nebenschilddrüsenoperation bei Patienten mit Multipler Endokriner Neoplasie
PARATHYROIDECTOMY IN PATIENTS WITH MEN1 SYNDROME
OPTIMAL TIMING FOR SURGERY
Hyperparathyroidism (HPT) is the most common endocrinopathy in patients with MEN1 syndrome (Multiple Endocrine Neoplasia syndrome, type 1). HPT is observed in almost all these patients and is typically the first manifestation of the MEN1 syndrome (usually observed early [at a young age, 20 - 25 years]).
Parathyroidectomy is the treatment of choice of HPT in MEN1. HPT in MEN1 is due to diffuse hyperplasia of the parathyroid glands. Despite that there is absolute indication for parathyroidectomy in MEN1 patients, the optimal timing for surgery remains somehow controversial.
Early parathyroidectomy offers the advantage of preventing the development of complications (such as nephrolithiasis, osteoporosis, osteopenia etc) due to increased levels of parathyroid for an extended period of time.
Late parathyroidectomy facilitates the recognition of the hyperplastic parathyroid glands because of the evolution of the hyperplastic process over the time.
Surgery for the management of HPT in MEN1 patients is associated with particular challenges. Recurrent HPT or hypoparathyroidism can occur following parathyroidectomy in patients with MEN1 syndrome. Extensive experience in endocrine surgery is required from the part of the operating surgeon, since there are available some options in surgical strategy in these patients and he/she will be called to make the right choices during surgery. The problem could be further complicated by the (not so uncommon) presence of supernumerary or ectopic parathyroid gland(-s).
