Pediatric endocrine surgery: A 20-year experience at the mayo clinic

A. Kundel, G. B. Thompson, M. L. Richards, L. X. Qiu, Y. Cai, F. W. Schwenk, A. N. Lteif, S. T. Pittock, S. Kumar, P. J. Tebben, I. D. Hay, C. S. Grant

Research output: Contribution to journalArticlepeer-review

42 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)399-406
Number of pages8
JournalJournal of Clinical Endocrinology and Metabolism
Volume99
Issue number2
DOIs
StatePublished - Feb 2014

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

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