LATE OUTCOME OF 304 CONSECUTIVE PATIENTS WITH MULTIPLE GLAND ENLARGEMENT IN PRIMARY HYPERPARATHYROIDISM TREATED BY CONSERVATIVE SURGERY

The aim of this study was to assess the late outcome of patients with primary hyperparathyroidism and multiple gland enlargement (MGE) treat ed by conservative surgery. MGE in primary hyperparathyroidism is the presence of two or more enlarged glands weighing more than 50 mg. Cons ervative surgery consists in resecting the grossly enlarged glands wit hout biopsying the normal glands. Some authors have suggested that thi s approach overlooks minute hyperplasia, leading to late recurrences o f hyperparathyroidism; conversely, it may result in the unnecessary re section of grossly enlarged, but not hyperfunctioning, glands. Altoget her 1231 patients mere operated on for primary hyperparathyroidism bet ween 1966 and 1995. Of these patients, 304 (24.9%) had MGE, including 42 cases of multiple endocrine neoplasia (MEN), 12 familial cases, and 250 seemingly sporadic cases. Two, three, or four glands (or more) we re involved in 61.8%, 21.4%, and 16.4% of cases, respectively. During the early postoperative period one patient died and ten mere reoperate d for persistent hypercalcemia. The pathologic diagnoses mere double a denomas (13.5%), hyperplasia (35.8%), association of the two (39.8%), and a normal second gland (10.8%) on light microscopy findings. None o f the 30 deaths that occurred during follow-up was related to hyperpar athyroidism. Altogether 190 patients (79%) mere available for follow-u p (average 89.3 months): 90% mere normocalcemic, 4.7% hypocalcemic, an d 5.2% hypercalcemic. A late iPTH assay was done in 147. PTH was appro priate to the serum calcium level in 84.3% and appropriate to normal c alcemia in 91.6% of 132 cases. Conservative surgery is thus an accepta ble treatment for MGE in patients with hyperparathyroidism. Few late r ecurrences occur, for which there are no individual predictive criteri a.