Ambulatory Parathyroidectomy for Primary Hyperparathyroidism

Irvin, George L.; Sfakianakis, George N.; Yeung, Luke; Deriso, George T.; Fishman, Lawrence M.; Molinari, Alberto; Foss, Joseph N.

doi:10.1001/archsurg.1996.01430220068015

Cited by 208 publications

(110 citation statements)

References 9 publications

Supporting

Mentioning

103

Contrasting

Unclassified

Order By: Relevance

“…This allowed a directed approach to identifying the affected gland, obviating the need to perform a traditional bilateral neck exploration of all glands. A further refinement of this approach has been the use of the rapid intraoperative PTH test in patients undergoing surgery in an outpatient or ambulatory setting (30,31 ).…”

Section: Early Development Of Intraoperative Pth Assaysmentioning

confidence: 99%

Rapid Intraoperative Immunoassay of Parathyroid Hormone and Other Hormones: A New Paradigm for Point-of-Care Testing

2004

View full text Add to dashboard Cite

Background:The first description of the use of a rapid assay for the measurement of intact parathyroid hormone (PTH) in patients undergoing parathyroidectomy for hyperparathyroidism was reported in 1988. Subsequent improvements in the analytical performance of the rapid intraoperative PTH assay allowed the establishment of its clinical utility in the surgical management of hyperparathyroidism. These modifications also allowed the assay to be performed in or near the operating suite. Methods: We searched MEDLINE, using the following key words: intraoperative, rapid, quick, parathyroid hormone, hormone, and immunoassay. Relevant articles that focused on the analytical aspects and clinical utility of rapid intraoperative hormone immunoassays were selected for this review. Content: On the basis of the positive impact that the rapid intraoperative PTH test has had on both patient outcomes and cost savings, other rapid intraoperative hormone immunoassays for the diagnosis and/or treatment of other endocrine-hormone-secreting tumors have been developed. These hormones share certain characteristics that make them suitable for use as rapid intraoperative tests, i.e., short analyte half-life and/or large analyte concentration gradient, rapid analysis time, and positive clinical utility. Initial studies with cortisol, gastrin, insulin, adrenocorticotropic hormone, and testosterone have shown promising results in pre-

show abstract

Section: Early Development Of Intraoperative Pth Assaysmentioning

confidence: 99%

Rapid Intraoperative Immunoassay of Parathyroid Hormone and Other Hormones: A New Paradigm for Point-of-Care Testing

2004

View full text Add to dashboard Cite

show abstract

“…In older patients, the operation is being performed increasingly under local anaesthesia (23). Because PTH is cleared from the circulation within minutes, intraoperative PTH assays indicate whether the patient has been cured or additional exploration is needed (24). Specifically, serum PTH concentrations fall by 50% or more after parathyroid adenomas are removed, and when that occurs, virtually all patients become normocalcemic.…”

Section: Management Of Primary Hyperparathyroidism -Treating Older Pamentioning

confidence: 99%

Primary hyperparathyroidism: diagnosis and management in the older individual

Boonen

Vanderschueren²,

Pelemans³

et al. 2004

European Journal of Endocrinology

View full text Add to dashboard Cite

As more and more cases of primary hyperparathyroidism are being detected by screening for serum calcium concentration, the majority of patients are older individuals who are asymptomatic or have symptoms which are difficult to ascribe to hyperparathyroidism. Long-term follow-up has provided evidence that most asymptomatic patients who do not undergo parathyroidectomy will not develop symptomatic complications. Some asymptomatic patients, however, have progression of disease over time. These observations and the lack of reliable predictors of the rate of progression in most patients reinforce the need for careful monitoring in elderly individuals who do not undergo surgery. Biannual measurements of serum calcium concentrations and annual measurements of urinary calcium excretion and bone mineral density should be performed in all patients who are managed conservatively. In elderly patients with symptomatic or complicated primary hyperparathyroidism, parathyroidectomy results in biochemical cure and increased bone density, both at the lumbar spine and the femoral neck, and should be considered. Criteria for surgery include significant hypercalcemia (.1 mg/dl above the upper limit of normal), marked hypercalciuria (. 400 mg per day), low bone density, unexplained renal insufficiency and an episode of acute primary hyperparathyroidism. Consideration of parathyroidectomy should also be given to elderly patients with primary hyperparathyroidism who are vitamin D deficient. Radionuclide scanning has become the initial non-invasive study of choice when parathyroid gland localization is necessary before parathyroidectomy; this is generally for fragile patients and reoperative cases. In a subset of older individuals, surgery may not be an option because of coexisting medical problems even though surgical indications are present.European Journal of Endocrinology 151 297-304

show abstract

“…Our simulation demonstrates that the technique of Irvin et al (5), still in use, would give a correct result in the first two simulated situations above, but result in a false-negative in the third case, where, with iPTH levels at 10 min less than 50%, the surgeon would not suspect the presence of a second adenoma.…”

Section: Discussionmentioning

confidence: 66%

The importance of the unsuppressed glands in the study of intact parathyroid hormone disappearance after parathyroid adenomectomy

Locchi

Tommasi

Brandi

et al. 2001

European Journal of Endocrinology

View full text Add to dashboard Cite

Background: In the usual techniques for intraoperative intact parathyroid hormone (iPTH) monitoring for primary hyperparathyroidism, the normal glands are implicitly considered suppressed. On the contrary, we believe, as do other researchers, that they are not totally suppressed. Methods: For this reason, we considered the introduction of an infusion from the unsuppressed normal glands (UNG), described by an influx constant (IC (pg/ml per min)), into the formulation of a two-compartment model. For the blood compartment, we have: Ct AXexp2at BXexp2bt EVY where A B EV iPTH concentration at zero time (clamping), EV (equilibrium value ICakỲ a' and`b' are reciprocals of the time constants of the two exponentials and k rate constant of elimination from the blood. The experimental data were obtained using an IRMA standard method, collecting samples in 20 patients, during and following adenomectomy. Results: In spite of the variability among the patients, all fits were very good, thus confirming the importance of the UNG contribution to the shaping of the disappearance curve. For this reason, the relationship between the constant infusion from the UNG and the basal iPTH level at the induction of anaesthesia (BV), was studied. Conclusions: The existence of a negative correlation, together with the determination of a regression curve IC 6X5BV 20X162 Y not only confirmed our assumptions, but also revealed the theoretical possibility of a priori knowledge of the iPTH contribution from the UNG. Hence, there is a theoretical possibility of discriminating between this contribution and that of the remaining (if any) affected gland(s).

show abstract

Ambulatory Parathyroidectomy for Primary Hyperparathyroidism

Cited by 208 publications

References 9 publications

Rapid Intraoperative Immunoassay of Parathyroid Hormone and Other Hormones: A New Paradigm for Point-of-Care Testing

Rapid Intraoperative Immunoassay of Parathyroid Hormone and Other Hormones: A New Paradigm for Point-of-Care Testing

Primary hyperparathyroidism: diagnosis and management in the older individual

The importance of the unsuppressed glands in the study of intact parathyroid hormone disappearance after parathyroid adenomectomy

Contact Info

Product

Resources

About