ArticleHormones (Athens, Greece)2026
How much is enough - surgical extent of initial parathyroidectomy and long-term outcomes in MEN1-related primary hyperparathyroidism.
Article in Hormones (Athens, Greece), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
contextMultiple endocrine neoplasia type 1 (MEN1)-associated primary hyperparathyroidism (pHPT) is typically multiglandular, which contributes to both persistent and recurrent disease following surgery. The optimal extent of initial parathyroidectomy in MEN1 remains debated.
objectiveTo evaluate long-term outcomes of subtotal parathyroidectomy (SPTX) and total parathyroidectomy with autotransplantation (TPTX-AT) versus less-than-subtotal parathyroidectomy (LSPTX) in MEN1-related pHPT, specifically regarding persistence, recurrence, permanent hypoparathyroidism, and need for reoperation.
methodsA retrospective cohort study was conducted including 65 MEN1 patients who underwent initial parathyroidectomy and were followed at a single tertiary referral center. Patients were stratified according to surgical extent (LSPTX vs SPTX/TPTX-AT). Recurrence was analyzed only among patients who had documented initial postoperative normocalcemia and evaluable follow-up; Kaplan-Meier curves were constructed for recurrence-free survival. Multivariable Cox regression was applied to identify independent predictors of adverse outcomes.
resultsThe median follow-up was 133.1 months (range 2.4-442.2 months). Nineteen patients underwent LSPTX and 46 underwent SPTX/TPTX-AT. Among patients evaluable for recurrence, recurrent pHPT occurred in 13/19 (68.4%) after LSPTX versus 16/45 (35.6%) after SPTX/TPTX-AT (Fisher's exact test, p = .027). Permanent hypoparathyroidism at last follow-up occurred in 2/17 (11.8%) and 10/45 (22.2%), respectively (p = 0.484). Recurrence-free survival was significantly shorter after LSPTX (log-rank p<0.001). In a parsimonious Cox model adjusted for age at surgery, LSPTX remained associated with shorter recurrence-free survival compared with SPTX/TPTX-AT (HR 6.11 (95% CI 2.64-14.17).
conclusionIn MEN1-related pHPT, limited parathyroidectomy (LSPTX) is associated with significantly higher recurrence rates and shorter recurrence-free survival. Although the risk of permanent hypoparathyroidism appeared lower after LSPTX, this difference did not reach statistical significance. These findings support subtotal parathyroidectomy as the preferred initial surgical strategy in most MEN1 patients, while emphasizing lifelong biochemical surveillance.
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