A follow-up study of patients with MEN syndromes - five case reports

Introduction: The aim of the study was evaluation of the results of surgical treatment in patients with hyperparathyroidism related to MEN syndrome. Material and methods: Five patients with MEN-related hyperparathyroidism were operated between January 1, 2010 and December 31, 2016 three women (60%) and two men (40%) aged between 17 and 72 years (mean 41.6 years). MEN1 syndrome was diagnosed in four patients and MEN2 only once. Pre- and postoperative results of PTH levels and serum calcium values were compared. Results: The mean preoperative serum PTH level was 215.56 pg/ml (from 113.4 to 376.6 pg/ml), whereas the mean preoperative serum calcium concentration was 1.40 mmol/l (from 1.15 to 1.50 mmol/l). Patients with MEN1 syndrome had three and two thirds of parathyroid gland taken in these three cases, including two cases with a partial thyroid removal, and the last one had a parathyroid biopsy performed. A patient with MEN2 syndrome had one parathyroid gland excised and Dunhill surgery of the thyroid gland performed. A diagnosis of the parathyroid adenoma accompanying medullary thyroid cancer required additional resections for the diseased thyroid parenchyma and the neck dissection. Postoperatively, we reported decreased secretion of both PTHs, ranging from 2.0 to 18.4 pg/ml (a mean serum PTH concentration 6.72 pg/ml), and serum calcium concentration between 0.9 and 1.25 mmol/l (a mean serum calcium concentration 1.11 mmol/l). One patient (25%) with MEN 1 developed recurrent hyperparathyroidism five years after the surgery. The patient was reoperated. The rest of the parathyroid gland was removed with an implantation into separated muscle pockets in the anterior forearm muscles. Conclusions: 1. MEN syndrome is a rare cause of primary hyperparathyroidism. 2. Subtotal parathyroidectomy helps to restore normal calcium metabolism. 3. Recurrence of hyperparathyroidism in patients with MEN syndrome requires total parathyroidectomy with an autotransplantation into the anterior forearm muscles.