Endocrine Abstracts

Recurrent primary hyperparathyroidism (RPHPT) is defined as hypercalcemia occurring after 6 months of normocalcemia following initial operation. The aim of this study was to analyze our experience in RPHPT.

Between 1980 and 2010 33 patients (1.2%) with primary hyperparathyroidism (HPT1) were reoperated in our tertiary referral centre for recurrence of disease: 24 adenomectomies, six subtotal parathyroidectomies, two total parathyroidectomies with autotransplantation and one negative exploration. Twenty-five patients had their primary intervention in our department.

Mean age at primary and secondary intervention was 50 and 63 years respectively. Mean time till recurrence was 12.8 years, not significantly different in uni- or multiglandular disease. In 22 patients contributing factors for recurrence could be identified: eight had a genetic compound (positive familial history, MEN-1 syndrome), eight had previous medical history of cervical radiotherapy, three cases of parathyroid carcinoma and three surgery itself (twice parathyreomatosis, one devascularised but not-identified adenoma). In 11 patients no risk factor was identified of which five had a metachronous adenoma. Mean calcium was preoperatively 2.71 mmol/l and PTH 120 pg/ml and postoperatively 2.25 mmol/l with PTH 27.5 pg/ml. Positive findings on ultrasound and MIBI-scintigraphy allowed for eighteen focussed surgical approaches. Morbidity following secondary intervention included one vocal cord palsy due to oncologic resection. Four patients (13%) were treated for temporary hypocalcemia and three patients (9.7%) had definitive hypoparathyroidism. Six patients were not cured, of which three patients died eventually from parathyroid carcinoma.

We may conclude that RPHPT is a rare disease. In 67% of the cases predisposing factors can be identified that should initiate prolonged follow-up of the patient. In contrast with persisting HPT1, recurrent HPT1 is rarely due to surgical failure.