Prophylactic surgery for multiple endocrine neoplasia type IIa after genetic diagnosis: Is parathyroid transplantation indicated?

被引:42
作者
Decker, RA
Geiger, JD
Cox, CE
Mackovjak, M
Sarkar, M
Peacock, ML
机构
[1] UNIV MICHIGAN,MED CTR,DEPT SURG,DIV ENDOCRINE SURG,ANN ARBOR,MI 48109
[2] UNIV MICHIGAN,MED CTR,DEPT PEDIAT SURG,ANN ARBOR,MI 48109
关键词
D O I
10.1007/s002689900124
中图分类号
R61 [外科手术学];
学科分类号
摘要
Identification of germline mutations in the RET proto-oncogene predisposing to multiple endocrine neoplasia type IIa (MEN-IIa) has allowed a DNA-based approach to diagnosis and treatment by prophylactic thyroidectomy in children testing genetically positive. Although total thyroidectomy is the accepted operation for C cell disease, the necessity of routine total parathyroidectomy and autotransplantation as previously described in these asymptomatic children is questionable, particularly given the low occurrence of hyperparathyroidism in MEN-IIa (10-20%). Thirty-six children (ages 1 month to 12 years) from four MEN-IIa kindreds at risk for disease underwent genetic testing. Mutational analysis was done using a highly sensitive PCR-based denaturing gradient gel electrophoresis technique. Parathyroid or serum calcium concentrations were determined preoperatively. Of the 36 children at risk, 18 were found to have a MEN-IIa mutation; 11 have undergone prophylactic thyroidectomy at ages ranging from 2 to 12 years (mean 7.5 years). In each case, there was no biochemical evidence of hypercalcemia preoperatively, and all parathyroid glands were identified and mere found to be grossly normal at exploration. Glands were carefully dissected and left in situ. Postoperatively, 10 of the 11 children maintained normocalcemia, allowing discharge within 24 to 36 hours. Resected thyroid glands contained C cell hyperplasia in nine, medullary carcinoma in one, and normal histology in one. We conclude that an alternative to routine parathyroidectomy may be desirable for prophylactic treatment of MEN-IIa. In situ parathyroid preservation fan be safely achieved without compromising the completeness of the thyroid resection. This conservative approach obviates the potential morbidity associated with total parathyroidectomy and autotransplantation.
引用
收藏
页码:814 / 821
页数:8
相关论文
共 30 条
[1]  
BOLINO A, 1995, ONCOGENE, V10, P2415
[2]   MUTATION DETECTION [J].
COTTON, RGH ;
MALCOLM, ADB .
NATURE, 1991, 353 (6344) :582-583
[3]   PROGRESS IN GENETIC SCREENING OF MULTIPLE ENDOCRINE NEOPLASIA TYPE 2A - IS CALCITONIN TESTING OBSOLETE [J].
DECKER, RA ;
PEACOCK, ML ;
BORST, MJ ;
SWEET, JD ;
THOMPSON, NW .
SURGERY, 1995, 118 (02) :257-264
[4]  
DECKER RA, 1992, SURGERY, V112, P1066
[5]  
DECKER RA, 1993, SURGERY, V114, P1059
[6]  
DIANZANI I, 1993, TIG, V9
[7]   MUTATIONS IN THE RET PROTOONCOGENE ARE ASSOCIATED WITH MEN 2A AND FMTC [J].
DONISKELLER, H ;
DOU, SS ;
CHI, D ;
CARLSON, KM ;
TOSHIMA, K ;
LAIRMORE, TC ;
HOWE, JR ;
MOLEY, JF ;
GOODFELLOW, P ;
WELLS, SA .
HUMAN MOLECULAR GENETICS, 1993, 2 (07) :851-856
[8]  
ENG C, 1995, ONCOGENE, V10, P509
[9]  
FABIEN N, 1994, INT J ONCOL, V4, P623
[10]   PRESYMPTOMATIC DNA SCREENING IN FAMILIES WITH MULTIPLE ENDOCRINE NEOPLASIA TYPE-2 AND FAMILIAL MEDULLARY-THYROID CARCINOMA [J].
FRILLING, A ;
DRALLE, H ;
ENG, C ;
RAUE, F ;
BROELSCH, CE .
SURGERY, 1995, 118 (06) :1099-1104