Miami Criterion for Recurrent Men-1 Related Hyperparathyroidism in the Forearm

Abstract BackgroundTotal parathyroidectomy with autotransplantation of parathyroid tissue to the forearm is one of the treatment modalities for primary hyperparathyroidism (PHPT) in multiple endocrine neoplasia type 1 (MEN 1). Recurrence rate with this approach has been documented in up to 35% of patients. The amount of tissue to be preserved during autograft debulking has not been well established.MethodsPreoperative assessment begins with biochemical confirmation of recurrent PHPT. Anatomic and functional imaging must be obtained. Intraoperative PTH monitoring is used to evaluate adequate amount of parathyroid tissue to be debulk pursuing more than 50% of PTH drop.ResultsOne patient with recurrent MEN1 related PHPT successfully underwent autograft debulking using the Miami criterion to assess adequate resection. The postoperative course was uneventful and on follow up the patient did not develop hypoparathyroidism.ConclusionThe use of Miami criterion during autograft debulking reoperations in the setting of MEN-1 is a feasible tool to achieve remission of primary hyperparathyroidism.