Primary hyperparathyroidism is a common endocrinopathy. Multiple Endocrine Neoplasia Type 1 (MEN1) is a rare autosomal dominantly inherited endocrine tumor predisposition syndrome, with one of main manifestations being primary hyperparathyroidism. We retrospectively evaluated a set of 1011 patients who underwent surgery for primary hyperparathyroidism between the years 2018-2022, and found 78 (8 %) patients who underwent reoperations and 27 patients with MEN1 syndrome. In the group of patients with MEN1 syndrome, 7 (35 %) needed reoperations. Patients with multiple endocrine neoplasia syndrome have a higher risk of needing reoperation. Genetic testing can help identify MEN1 syndrome preoperatively and to better evaluate the approach to surgery.

3rd Department of Surgery 1st Faculty of Medicine Charles University Prague and Motol University Hospital Prague Czech Republic

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Venkat R, Kouniavsky G, Tufano RP, Schneider EB, Dackiw AP, Zeiger MA. Long-term outcome in patients with primary hyperparathyroidism who underwent minimally invasive parathyroidectomy. World J Surg. 2012;36:55–60. doi: 10.1007/s00268-011-1344-8. PubMed DOI

Yeh MW, Wiseman JE, Chu SD, Ituarte PH, Liu IL, Young KL, Kang SJ, Harari A, Haigh PI. Population-level predictors of persistent hyperparathyroidism. Surgery. 2011;150:1113–1119. doi: 10.1016/j.surg.2011.09.025. PubMed DOI

Pieterman CR, van Hulsteijn LT, den Heijer M, van der Luijt RB, Bonenkamp JJ, Hermus AR, Borel Rinkes IH, Vriens MR, Valk GD DutchMEN1 Study Group. Primary hyperparathyroidism in MEN1 patients: a cohort study with longterm follow-up on preferred surgical procedure and the relation with genotype. Ann Surg. 2012;255:1171–1178. doi: 10.1097/SLA.0b013e31824c5145. PubMed DOI

Salmeron MD, Gonzalez JM, Sancho Insenser J, Goday A, Perez NM, Zambudio AR, Paricio PP, Serra AS. Causes and treatment of recurrent hyperparathyroidism after subtotal parathyroidectomy in the presence of multiple endocrine neoplasia 1. World J Surg. 2010;34:1325–1331. doi: 10.1007/s00268-010-0605-2. PubMed DOI

Marx SJ, Simonds WF, Agarwal SK, Burns AL, Weinstein LS, Cochran C, Skarulis MC, Spiegel AM, Libutti SK, Alexander HR, Jr, Chen CC, Chang R, Chandrasekharappa SC, Collins FS. Hyperparathyroidism in hereditary syndromes: special expressions and special managements. J Bone Miner Res. 2002;17(Suppl 2):N37–N43. PubMed

Wilhelm SM, Wang TS, Ruan DT, Lee JA, Asa SL, Duh QY, Doherty GM, Herrera MF, Pasieka JL, Perrier ND, Silverberg SJ, Solórzano CC, Sturgeon C, Tublin ME, Udelsman R, Carty SE. The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism. JAMA Surg. 2016;151:959–968. doi: 10.1001/jamasurg.2016.2310. PubMed DOI

Marini F, Cianferotti L, Giusti F, Brandi ML. Molecular genetics in primary hyperparathyroidism: the role of genetic tests in differential diagnosis, disease prevention strategy, and therapeutic planning. A 2017 update. Clin Cases Miner Bone Metab. 2017;14:60–70. doi: 10.11138/ccmbm/2017.14.1.060. PubMed DOI PMC

Nawrot I, Chudziński W, Ciąćka T, Barczyński M, Szmidt J. Reoperations for persistent or recurrent primary hyperparathyroidism: results of a retrospective cohort study at a tertiary referral center. Med Sci Monit. 2014;20:1604–1612. doi: 10.12659/MSM.890983. PubMed DOI PMC

Richards ML, Thompson GB, Farley DR, Grant CS. Reoperative parathyroidectomy in 228 patients during the era of minimal-access surgery and intraoperative parathyroid hormone monitoring. Am J Surg. 2008;196:937–942. doi: 10.1016/j.amjsurg.2008.07.022. discussion 942–943. PubMed DOI

Parikh AM, Grogan RH, Morón FE. Localization of parathyroid disease in reoperative patients with primary hyperparathyroidism. Int J Endocrinol. 2020;2020:ID:9649564. doi: 10.1155/2020/9649564. PubMed DOI PMC

Henry JF. Reoperation for primary hyperparathyroidism: tips and tricks. Langenbecks Arch Surg. 2010;395:103–109. doi: 10.1007/s00423-009-0560-2. PubMed DOI

Hessman O, Stålberg P, Sundin A, Garske U, Rudberg C, Eriksson LG, Hellman P, Akerström G. High success rate of parathyroid reoperation may be achieved with improved localization diagnosis. World J Surg. 2008;32:774–781. doi: 10.1007/s00268-008-9537-5. PubMed DOI