Surgical Extent in MEN1-Associated Hyperparathyroidism: Balancing Recurrence, Hypoparathyroidism and Quality of Life — ASN Events
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Surgical Extent in MEN1-Associated Hyperparathyroidism: Balancing Recurrence, Hypoparathyroidism and Quality of Life (#302)

Jessica Bindra 1 2 3 , Lyndal Tacon 1 2 , Roderick Clifton-Bligh 1 2 3
  1. Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
  2. Department of Endocrinology, Royal North Shore Hospital, Sydney, NSW, Australia
  3. Cancer Genetics and Diagnostics Laboratory, Kolling Institute, Sydney, NSW, Australia

Surgical management of multiple endocrine neoplasia type 1 (MEN1)-associated hyperparathyroidism requires balancing disease recurrence against iatrogenic morbidity, notably permanent hypoparathyroidism. Consensus on optimal extent of initial parathyroidectomy remains lacking.1,2 We compared rates of recurrence and surgical morbidity between minimally invasive parathyroidectomy (MIP) and subtotal parathyroidectomy (STP), and examined associations between surgical extent, biochemical outcomes, and health-related quality of life (HRQOL).

We retrospectively analysed 49 patients with MEN1 undergoing initial parathyroidectomy: MIP (1-2 glands, n=25), STP (3-3.5 glands, n=23), and total parathyroidectomy with autotransplantation (n=1, excluded from analysis). Rates of persistent and recurrent disease, transient and permanent hypoparathyroidism, and permanent recurrent laryngeal nerve palsy were compared using Fisher's exact and Mann–Whitney U tests. HRQOL was assessed using the SF-36, HRQOL-14, and Impact of Event Scale–Revised (IES-R).

HRQOL scores were globally lower following STP than MIP, with significantly lower emotional wellbeing in patients after STP than MIP (median 44.0 [IQR 32.5–69.0]) vs 68.0 [IQR 56.0–80.0]; p=0.02). Permanent hypoparathyroidism was more common after STP than MIP (23.8% vs 9.1%), although this difference was not statistically significant (p=0.24). Across both operative approaches, permanent hypoparathyroidism was associated with poorer physical function (mean difference 28.5, 95% CI 4.7–52.3; p=0.02) and greater clinical distress (78.2% vs 40.3%; OR 6.40, p=0.03). Although disease recurrence was more frequent following MIP than STP (69.6% vs 40.9%; OR 0.30, p=0.08), this difference did not reach statistical significance and should be interpreted in the context of the longer median follow-up in the MIP group (13 vs 7 years).

More extensive initial resection may reduce recurrence at the expense of increased permanent hypoparathyroidism and impaired HRQOL, particularly emotional wellbeing. Surgical decision-making in MEN1 should incorporate individualised risk-benefit assessment, weighing recurrence risk against the HRQOL burden of permanent hypoparathyroidism. Prospective studies with validated HRQOL measures are warranted to inform individualised surgical guidelines.

  1. Thakker et al. Clinical Practice Guidelines for Multiple Endocrine Neoplasia Type 1 (MEN1). J Clin Endocrinol Metab. 2012;97(9):2990-3011.
  2. Brandi M, Pieterman C, English K et al. Multiple endocrine neoplasia type 1 (MEN1): recommendations and guidelines for best practice. The Lancet Diabetes & Endocrinology, 2025; 13, 699-721