Correlation of Intraoperative Parathyroid Hormone Levels With Parathyroid Gland Size

Moretz, William H.; Watts, Tammara L.; Virgin, Frank W.; Chin, Edward; Gourin, Christine G.; Terris, David J.

doi:10.1097/mlg.0b013e31813c14fc

Cited by 46 publications

(48 citation statements)

References 9 publications

(23 reference statements)

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“…First, this study includes a substantially higher number of patients (n = 1235). Second, and similar to the findings of Moretz et al, 23 we did identify a highly significant correlation of both calcium levels and PTH levels with the gland weight. Finally, we used this correlation to create the WIN that capitalizes on this correlation to assist with intraoperative decision-making.…”

Section: Discussionsupporting

confidence: 88%

Creation of a “Wisconsin Index” Nomogram to Predict the Likelihood of Additional Hyperfunctioning Parathyroid Glands During Parathyroidectomy

Mazeh¹,

Chen²,

Leverson³

et al. 2013

Annals of Surgery

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Section: Discussionsupporting

confidence: 88%

Creation of a “Wisconsin Index” Nomogram to Predict the Likelihood of Additional Hyperfunctioning Parathyroid Glands During Parathyroidectomy

Mazeh¹,

Chen²,

Leverson³

et al. 2013

Annals of Surgery

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“…Contrary to some studies, two studies have found a significant positive correlation between preoperative calcium levels and the weight of the adenomas 4 5. However, no correlation was found between the weight of the adenoma and the preoperative PTH contrary to the findings discussed in one of the studies published in the 1980 6.…”

Section: Discussionmentioning

confidence: 71%

Bilateral femoral fractures in a 21-year-old man following a simple fall

French

Oweis²,

Kurup

2013

BMJ Case Reports

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SUMMARYWe present a case of a 21-year-old man with hip pain to the orthopaedic team. During the initial assessment he was found to be hypercalcaemic (adjusted calcium 3.55) due to the primary hyperparathoidism (PTH 1285), with all other screening for multiple endocrine neoplasia negative. During his time on the ward while being treated for the hypercalcaemia he had a fall resulting in bilateral femoral fractures, requiring surgical management. He underwent an emergency exploration of neck and excision of a large parathyroid adenoma, measuring 5.5 cm. He also developed renal failure as a result of nephrocalcinosis. This case highlights the importance of early detection and management of hyperparathyroidism with the aim of preventing longterm complications. This patient ultimately required a renal transplant and multiple orthopaedic procedures as a result of undiagnosed PTH and recently underwent excision of the remaining parathyroid glands. BACKGROUND

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“…To further stress the benefit of PTH in preoperative diagnosis, Robert et al suggested that a PTH level <4 times the upper limit of normal excludes a malignancy [4]. Other studies support the above trend—a recent case series looking at solitary adenomas causing asymptomatic disease have derived mean values of Preoperative PTH as 186 [5] and 165 ng/L [6], while research into carcinoma show higher PTH levels of 714 [2] and 1220 ng/L [7]. This consolidates the unusual nature of a PTH level of 3957 ng/L in an adenoma with no radiological, Intraoperative, or histological evidence of malignancy.…”

Section: Discussionmentioning

confidence: 99%

A Parathyroid Adenoma: Benign Disease Presenting with Hyperparathyroid Crisis

Tahim

Saunders

Sinha

2010

Case Reports in Medicine

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Hyperparathyroid crisis is a rare manifestation of parathyroid disease. We present the case of a 53-year-old gentleman with a review of the current literature. He presented in acute renal failure with epigastric pain and vomiting. His serum-corrected calcium (CCa2+) was raised at 5.2 mmol/L, in addition to a massively raised parathyroid hormone (PTH) level (3957 ng/L). Ultrasound studies of the neck revealed a 2 cm well-defined mass inferoposterior to right thyroid lobe. CT scans of the neck showed a normal mediastinum and confirmed no associated lymphadenopathy. Having undergone medical resuscitation for 9 days, a neck exploration revealed a cystic mass, which was excised. Histological investigations revealed a 9.25 g, cystic parathyroid adenoma with no features of malignancy. His PTH and CCa2+ returned to normal postoperatively. This suspicious presentation of benign disease, including a marked elevation in PTH, highlights the challenges facing the endocrine surgeon in dealing with parathyroid disease.

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Correlation of Intraoperative Parathyroid Hormone Levels With Parathyroid Gland Size

Abstract: Preoperative serum calcium and baseline iPTH levels may be useful in predicting parathyroid adenoma weight and volume, respectively. Adenoma weight may relate to the percentage decrease of iPTH levels at the 10-minute postparathyroidectomy interval.

Cited by 46 publications

References 9 publications

Creation of a “Wisconsin Index” Nomogram to Predict the Likelihood of Additional Hyperfunctioning Parathyroid Glands During Parathyroidectomy

Creation of a “Wisconsin Index” Nomogram to Predict the Likelihood of Additional Hyperfunctioning Parathyroid Glands During Parathyroidectomy

Bilateral femoral fractures in a 21-year-old man following a simple fall

A Parathyroid Adenoma: Benign Disease Presenting with Hyperparathyroid Crisis

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