Primary hyperparathyroidism in patients with multiple endocrine neoplasia type 1: Impact of genotype and surgical approach on long-term postoperative outcomes

BACKGROUND

Protein-truncating germline pathogenic variants in the N- and C-terminal exons (2, 9, and 10) of the MEN1 gene may be associated with aggressive pancreatic neuroendocrine tumors. However, the impact of these variants on parathyroid disease is poorly understood. We sought to investigate the effects of genotype and surgical approach on clinical phenotype and postoperative outcomes in patients with multiple endocrine neoplasia type 1 (MEN1)-related primary hyperparathyroidism.

METHODS

We identified patients with MEN1 evaluated at our institution from 1985 to 2020 and stratified them by genotype, (truncating variants in exons 2, 9, or 10, or other variants), and index surgical approach, (less-than-subtotal parathyroidectomy [

RESULTS

Of the 209 patients we identified, primary hyperparathyroidism was diagnosed in 194 (93%) and at a younger median age in those with truncating exon 2, 9, or 10 variants compared with other variants (27 years vs 31 years; P = .006). Median disease-free survival was significantly worse in patients who underwent

CONCLUSION

The MEN1 genotype may affect the age of onset of primary hyperparathyroidism and the time to recurrence after surgery. Collapse

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MESH Headings

• Humans
• Adult
• Multiple Endocrine Neoplasia Type 1/complications
• Multiple Endocrine Neoplasia Type 1/genetics
• Multiple Endocrine Neoplasia Type 1/surgery
• Hyperparathyroidism, Primary/genetics
• Hyperparathyroidism, Primary/surgery
• Hyperparathyroidism, Primary/epidemiology
• Neoplasm Recurrence, Local/surgery
• Parathyroidectomy/adverse effects
• Hypoparathyroidism/etiology
• Genotype

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Affiliation(s)

Omair A Shariq Department of Surgery, Mayo Clinic, Rochester, MN.
Vitor B Abrantes Department of Surgery, Mayo Clinic, Rochester, MN
Lauren Y Lu Department of Surgery, Mayo Clinic, Rochester, MN
Peter J Tebben Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
Trenton M Foster Department of Surgery, Mayo Clinic, Rochester, MN
Benzon M Dy Department of Surgery, Mayo Clinic, Rochester, MN
Melanie L Lyden Department of Surgery, Mayo Clinic, Rochester, MN
William F Young Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
Travis J McKenzie Department of Surgery, Mayo Clinic, Rochester, MN

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