Clinical impact of two different intraoperative parathyroid hormone assays in primary and renal hyperparathyroidism

Abstract

Background: Intraoperative parathyroid hormone (PTH) monitoring predicts successful surgery for primary hyperparathyroidism (pHPT). In renal HPT, intraoperative PTH assays can define whether parathyroid resection is adequate. Methods: Intraoperative PTH was measured with two different immunometric assays (Immulite Turbo DPC and ADVIA Centaur assay) in 91 patients undergoing parathyroidectomy for primary (nZ57) and renal (nZ34) hyperparathyroidism. PTH was monitored preoperatively, 10, 20, and 30 min after parathyroidectomy and 24 h postoperatively. Results: Ten minutes after parathyroidectomy, intraoperative PTH dropped into the normal range (!7.6 pmol/l) in 84% of patients with pHPT and tertiary HPT as measured with the ADVIA Centaur assay (PTH-A), compared with 100% of the samples measured with the Immulite Turbo DPC assay (PTH-I; PZ0.0082). Twenty minutes after parathyroidectomy for secondary HPT, intraoperative PTH decreased to the normal range in 100% measured with PTH-I compared with 50% measured with PTH-A (PZ0.009). Then, 24 h postoperatively, PTH-I and PTH-A levels were within the normal range in all of the successfully treated patients. Both assays correctly identified six patients with persistent disease and another patient with a double adenoma in pHPT. Conclusions: In patients undergoing parathyroidectomy for primary or renal HPT, PTH levels decreasing to the normal range indicated successful surgery in all of the patients as measured with the PTH-I assay. Comparing the two assays, PTH-I was able to quantify the intraoperative PTH decay more quickly than PTH-A.

C-11 Methionine Positron Emission Tomography/Computed Tomography Localizes Parathyroid Adenomas in Primary Hyperparathyroidism

“…Positive preoperative localization studies enable limited surgical strategies, for example, unilateral neck exploration, which may be performed through an open or a minimally invasive approach [2,3] . Intraoperative PTH measurement helps the surgeon to verify the complete removal of hyperfunctioning parathyroid tissue [4,5] . In specialized centers, surgical management of hyperparathyroidism results in successful excision of parathyroid adenomas in more than 90 % of the patients [6,7] .…”

The Necessity and Reliability of Intraoperative Parathyroid Hormone (PTH) Testing in Patients with Mild Hyperparathyroidism and PTH Levels in the Normal Range

“…Primary hyperparathyroidism is caused by a single parathyroid adenoma in about 80–85% of the cases. In about 15% multiple gland hyperplasia, double adenomas, or, very rarely, parathyroid carcinomas are diagnosed [3].…”

Intraoperative Parathyroid Hormone Monitoring Corroborates the Success of Parathyroidectomy in Children

“…Several options have been reported for timing of PTH testing during surgery ( 7 , 8 ). Many surgeons accept a successful resection as more than a 50% decrease at the 10th minute, but this could be misleading in multi-glandular disease ( 6 , 7 , 8 ). In our study, a curative resection is defined as a more than 90% decrease in PTH levels from baseline at 20 minutes following resection ( 9 ).…”

“…In recent years, PTH monitoring during parathyroidectomy became more popular in adults to improve cure rates ( 4 , 6 , 7 , 8 ). There are very few reports about PTH monitoring in childhood ( 5 ).…”