Treatments for MEN1-associated endocrine tumours: three systematic reviews and a meta-analysis
Pooled result · Q1: persistent PHPTResult — go to the resultRelative risk 0.32 95% CI 0.20–0.52Authors' conclusion
In patients with MEN1, subtotal parathyroidectomy achieved greater reductions in persistence and recurrence of primary hyperparathyroidism than less than subtotal parathyroidectomy; for non-functioning pancreatic neuroendocrine tumours sized 2 cm or less, the few available studies suggest that active surveillance might be comparable to surgical resection; and for prolactinomas, dopamine agonist therapy appears to have comparable efficacy as in patients without MEN1.
Study context
- Population
- Adults and children with MEN1-associated tumours; RCTs, cohort, case-control and case series; databases searched Dec 1, 2001, to Feb 13, 2023
- Comparison
- Q1: subtotal vs less than subtotal parathyroidectomy for PHPT; Q2: surgery vs active surveillance for non-functioning pancreatic NET ≤2 cm; Q3: dopamine agonist response of prolactinomas in MEN1 vs non-MEN1
- Outcome
- Q1: persistent PHPT
Methodological detailsthree systematic reviews, random-effects model, prospectively registered, no language restrictions, GRADE certainty low or very low for all
- Three systematic reviews
- Random-effects model
- Prospectively registered
- No language restrictions
- GRADE certainty low or very low for all
Pooled result
As reported in the abstract
Relative risk
0.32
95% CI 0.20–0.52
Subtotal parathyroidectomyvs Less than subtotal parathyroidectomy
RR 0.32 (95% CI 0.20–0.52)
Further pooled results
| Outcome | RR (CI) | |
|---|---|---|
| Q1: recurrent PHPTSubtotal parathyroidectomyvs Less than subtotal parathyroidectomyI2=27% | 0.78 (0.62–0.97) | |
| 0.512Relative risk (log scale) |
Q2: combined metastatic disease and mortality
- Surgery, range across studies
- two [7%] of 27 to three [20%] of 15
- Active surveillance, range across studies
- one [3%] of 33 to four [8%] of 50
- Comparable between surgery and active surveillance
- Three cohort studies
Q3: dopamine agonist failure to normalise serum prolactin
- MEN1, range across studies
- zero of one to one [33%] of three
- Without MEN1, range across studies
- four [6%] of 68 to nine (82%) of 11
- Similar between MEN1 and without MEN1
- Ten studies, 505 patients
Safety
| Outcome | RR (CI) | |
|---|---|---|
| Q1: post-operative hypoparathyroidismSubtotal parathyroidectomyvs Less than subtotal parathyroidectomyI2=0%; higher with subtotal | 2.64 (1.63–4.29) | |
| 0.20.5125Relative risk (log scale) |
Original publication
Treatments for MEN1-associated endocrine tumours: three systematic reviews and a meta-analysis. Lancet Diabetes Endocrinol. Published 13 June 2025. doi:10.
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