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(Referência obtida automaticamente do Web of Science, por meio da informação sobre o financiamento pela FAPESP e o número do processo correspondente, incluída na publicação pelos autores.)

Total parathyroidectomy in a large cohort of cases with hyperparathyroidism associated with multiple endocrine neoplasia type 1: experience from a single academic center

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Autor(es):
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de Menezes Montenegro, Fabio Luiz [1] ; Lourenco Junior, Delmar Muniz [2] ; Tavares, Marcos Roberto [1] ; Arap, Sergio Samir [1] ; Nascimento Junior, Climerio Pereira [1] ; Massoni Neto, Ledo Mazzei [1] ; D'Alessandro, Andre [1] ; Toledo, Rodrigo Almeida [2] ; Coutinho, Flavia Lima [2] ; Brandao, Lenine Garcia [1] ; de Britto e Silva Filho, Gilberto [1] ; Cordeiro, Anoi Castro [1] ; Almeida Toledo, Sergio Pereira [2]
Número total de Autores: 13
Afiliação do(s) autor(es):
[1] Univ Sao Paulo, Fac Med, Hosp Clin, Head & Neck Surg Sect, Dept Surg, Sao Paulo - Brazil
[2] Univ Sao Paulo, Fac Med, Hosp Clin, Endocrine Genet Unit, Endocrinol Div, Sao Paulo - Brazil
Número total de Afiliações: 2
Tipo de documento: Artigo de Revisão
Fonte: Clinics; v. 67, n. 1, p. 131-139, 2012.
Citações Web of Science: 12
Resumo

Most cases of sporadic primary hyperparathyroidism present disturbances in a single parathyroid gland and the surgery of choice is adenomectomy. Conversely, hyperparathyroidism associated with multiple endocrine neoplasia type 1 (hyperparathyroidism/multiple endocrine neoplasia type 1) is an asynchronic, asymmetrical multiglandular disease and it is surgically approached by either subtotal parathyroidectomy or total parathyroidectomy followed by parathyroid auto-implant to the forearm. In skilful hands, the efficacy of both approaches is similar and both should be complemented by prophylactic thymectomy. In a single academic center, 83 cases of hyperparathyroidism/multiple endocrine neoplasia type 1 were operated on from 1987 to 2010 and our first surgical choice was total parathyroidectomy followed by parathyroid auto-implant to the non-dominant forearm and, since 1997, associated transcervical thymectomy to prevent thymic carcinoid. Overall, 40% of patients were given calcium replacement (mean intake 1.6 g/day) during the first months after surgery, and this fell to 28% in patients with longer follow-up. These findings indicate that several months may be needed in order to achieve a proper secretion by the parathyroid auto-implant. Hyperparathyroidism recurrence was observed in up to 15% of cases several years after the initial surgery. Thus, long-term follow-up is recommended for such cases. We conclude that, despite a tendency to subtotal parathyroidectomy worldwide, total parathyroidectomy followed by parathyroid auto-implant is a valid surgical option to treat hyperparathyroidism/multiple endocrine neoplasia type 1. Larger comparative systematic studies are needed to define the best surgical approach to hyperparathyroidism/multiple endocrine neoplasia type 1. (AU)

Processo FAPESP: 09/15386-6 - Análise dos genes CDKN1A, CDKN1B, CDKN2B e CDKN2C, nas Neoplasias Endócrinas Múltiplas tipo 1 e 2
Beneficiário:Rodrigo de Almeida Toledo
Linha de fomento: Bolsas no Brasil - Pós-Doutorado