Endocrine Abstracts

Introduction: Primary hyperparathyroidism in Multiple Endocrine Neoplasia (MEN) syndromes presents surgical challenges due to multiglandular involvement and recurrence risk. Clinical guidelines recommend a minimum of subtotal parathyroidectomy for MEN1 patients, while MEN2A patients require selective removal of enlarged glands only, due to heterogeneous clinical manifestations. We analysed perioperative and long-term outcomes following parathyroidectomy in MEN patients treated at specialised tertiary referral centre.

Methods: We reviewed 9 MEN patients (7 MEN1, 2 MEN2A) who underwent parathyroidectomy, analysing patient characteristics, preoperative laboratory investigations, surgical techniques, and outcomes. The cohort was predominantly female (77.8%) with a mean age of 39.6 years.

Results: Nine patients (7 females, 2 males; median 40 years, range 24-51) with MEN1 (n = 7) or MEN2A (n = 2) underwent parathyroidectomy for hyperparathyroidism. Preoperative mean Parathyroid Hormone (15.3 pmol/l), calcium (2.80 mmol/l) met surgical criteria per established guidelines. Extensive parathyroid resection achieved complete biochemical normalisation (PTH 3.6 pmol/l, calcium 2.20 mmol/l) with 100% initial cure rate. Long-term outcomes demonstrated 12.5% recurrence and 25% permanent hypoparathyroidism rates, comparable to published international data (16-60% recurrence, up to 50% hypoparathyroidism), highlighting inherent complexity of managing hereditary hyperparathyroidism in MEN syndromes.

Conclusion: Parathyroidectomy effectively controls MEN-associated primary hyperparathyroidism, with extensive resection as standard treatment for MEN1 patients. Long-term outcomes show a 12.5% recurrence versus 25% permanent hypoparathyroidism. These results support current management approaches and emphasise need for individualised surgical strategies that balance cure rates with long-term disease control while minimising complications in this genetic syndrome