TY - JOUR
T1 - Pediatric endocrine surgery
T2 - A 20-year experience at the mayo clinic
AU - Kundel, A.
AU - Thompson, G. B.
AU - Richards, M. L.
AU - Qiu, L. X.
AU - Cai, Y.
AU - Schwenk, F. W.
AU - Lteif, A. N.
AU - Pittock, S. T.
AU - Kumar, S.
AU - Tebben, P. J.
AU - Hay, I. D.
AU - Grant, C. S.
PY - 2014/2
Y1 - 2014/2
N2 - Context: Surgically managed endocrinopathies are rare in children. Most surgeons have limited experience in this field. Herein we report our operative experience with pediatric patients, performed over two decades by high-volume endocrine surgeons. Setting: The study was conducted at the Mayo Clinic (a tertiary referral center). Patients: Patients were <19 years old and underwent an endocrine operation (1993-2012). Main Outcome Measures: Demographics, surgical procedure, diagnoses, morbidity, and mortality were retrospectively reviewed. Results: A total of 241 primary cases included 177 thyroid procedures, 13 neck dissections, 24 parathyroidectomies, 14 adrenalectomies, 7 paragangliomas, and 6 pancreatic procedures. Average age of patientswas14.2 years. There were 133 total thyroidectomiesand40 hemithyroidectomies. Fifty-three cases underwent a central or lateral neck dissection. Six-month follow-up was available for 98 total thyroidectomy patients. There were four cases of permanent hypoparathyroidism (4%) and no permanent recurrent laryngeal nerve (RLN) paralyses. Sequelae of neck dissections included temporary RLN neurapraxia and Horner's syndrome. Parathyroidectomy was performed on 24 patients: 20 with primary hyperparathyroidism (HPT), three with tertiary HPT, and one with familial hypocalciuric hypocalcemia. Three patients (16%) had recurrent HPT, all with multiglandular disease. One patient had temporary RLN neurapraxia. We performed seven bilateral and seven unilateral adrenalectomies; eight were laparoscopic. Indications included pheochromocytoma, Cushing's syndrome, adrenocortical carcinoma, congenital adrenal hyperplasia, and ganglioneuroma. One death was due to adrenocortical carcinoma. Five paraganglioma patients had succinate dehydrogenase subunit B mutations, andonerecurred. Six patientswithinsulinomaunderwentenucleation(n-5)ordistalpancreatectomy (n = 1). A single postoperative abscess was managed nonoperatively. Conclusion: Pediatric endocrine procedures are uncommon but can be safely performed with complication rates comparable to those of the adult population. It is imperative that these operations be performed by high-volume surgeons.
AB - Context: Surgically managed endocrinopathies are rare in children. Most surgeons have limited experience in this field. Herein we report our operative experience with pediatric patients, performed over two decades by high-volume endocrine surgeons. Setting: The study was conducted at the Mayo Clinic (a tertiary referral center). Patients: Patients were <19 years old and underwent an endocrine operation (1993-2012). Main Outcome Measures: Demographics, surgical procedure, diagnoses, morbidity, and mortality were retrospectively reviewed. Results: A total of 241 primary cases included 177 thyroid procedures, 13 neck dissections, 24 parathyroidectomies, 14 adrenalectomies, 7 paragangliomas, and 6 pancreatic procedures. Average age of patientswas14.2 years. There were 133 total thyroidectomiesand40 hemithyroidectomies. Fifty-three cases underwent a central or lateral neck dissection. Six-month follow-up was available for 98 total thyroidectomy patients. There were four cases of permanent hypoparathyroidism (4%) and no permanent recurrent laryngeal nerve (RLN) paralyses. Sequelae of neck dissections included temporary RLN neurapraxia and Horner's syndrome. Parathyroidectomy was performed on 24 patients: 20 with primary hyperparathyroidism (HPT), three with tertiary HPT, and one with familial hypocalciuric hypocalcemia. Three patients (16%) had recurrent HPT, all with multiglandular disease. One patient had temporary RLN neurapraxia. We performed seven bilateral and seven unilateral adrenalectomies; eight were laparoscopic. Indications included pheochromocytoma, Cushing's syndrome, adrenocortical carcinoma, congenital adrenal hyperplasia, and ganglioneuroma. One death was due to adrenocortical carcinoma. Five paraganglioma patients had succinate dehydrogenase subunit B mutations, andonerecurred. Six patientswithinsulinomaunderwentenucleation(n-5)ordistalpancreatectomy (n = 1). A single postoperative abscess was managed nonoperatively. Conclusion: Pediatric endocrine procedures are uncommon but can be safely performed with complication rates comparable to those of the adult population. It is imperative that these operations be performed by high-volume surgeons.
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U2 - 10.1210/jc.2013-2617
DO - 10.1210/jc.2013-2617
M3 - Article
C2 - 24423286
AN - SCOPUS:84893737867
SN - 0021-972X
VL - 99
SP - 399
EP - 406
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 2
ER -