Diagnostic Accuracy Study of Intraoperative and Perioperative Serum Intact PTH Level for Successful Parathyroidectomy in 501 Secondary Hyperparathyroidism Patients

Zhang, Lína; Xing, Changying; Shen, Chong; Zhang, Ming; Yang, Guang; Mao, Huijuan; Zhang, Bo; Yu, Xiangbao; Cui, Yiyao; Sun, Bin; Ouyang, Chun; Ge, Yifei; Jiang, Yao; Chen, Yin; Zhang, Xiaoming; Wang, Ningning

doi:10.1038/srep26841

Cited by 49 publications

(61 citation statements)

References 22 publications

(29 reference statements)

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“…The current patient's iPTH levels were measured at 10 and 20 min after surgical excision of his hyperparathyroid glands and again on the first and fourth days postoperatively. We proved that for TPTX to be successful, there should be a 82.9% decline in serum iPTH levels after 10 min (sensitivity 85.5% and specificity 73.1%) and 88.9% at 20 min (sensitivity 78.6% and specificity 88.5%) . Blood iPTH >100.5 pg/mL on day 1 (sensitivity 100% and specificity 98.6%) and iPTH >147.4 pg/mL on day 4 (sensitivity 100% and specificity 99.5%) after the operation are considered indicative of persistent SHPT .…”

Section: Discussionmentioning

confidence: 81%

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Sixty‐Two‐Year‐Old Male Suffering From Uremic Leontiasis Ossea Caused by Severe Secondary Hyperparathyroidism

et al. 2018

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Secondary hyperparathyroidism (SHPT) is a long‐term complication of chronic kidney disease–mineral and bone disorder (CKD‐MBD). SHPT is characterized by hyperplasia of the parathyroid glands and abnormal secretion of parathyroid hormones (PTH), calcium and phosphorous metabolic disorders, renal osteodystrophy, vascular and soft tissue calcification, malnutrition, and other multiple system complications, which can seriously affect the quality of life of the patient and increase the risk of cardiovascular disease and mortality rate. Uremic leontiasis ossea (ULO) is a medical condition only rarely encountered clinically. SHPT causes craniofacial bone deformity accompanied by lesions of the nerve, cardiovascular, respiratory, bone, or other systems within the body. The case discussed here is related to severe SHPT. A 62‐year‐old male patient was suffering from leontiasis ossea, pectus excavatum, vascular calcification, spontaneous bone fractures, and lower limb deformities. He was undergoing hemodialysis and given total parathyroidectomy (TPTX) with autotransplantation (AT). We further analyzed the multivariate therapeutic effects of TPTX on this patient in order to provide clinical data for standardized treatment of individuals with CKD‐MBD. © 2018 The Authors JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

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Section: Discussionmentioning

confidence: 81%

“…. Serum iPTH levels were measured using a UniCel DxI800 Access Immunoassy System (Beckman Coulter, Inc., Fullerton, CA, USA) . Vitamin D and calcium (Ca) supplements were prescribed.…”

Section: Casementioning

confidence: 99%

Sixty‐Two‐Year‐Old Male Suffering From Uremic Leontiasis Ossea Caused by Severe Secondary Hyperparathyroidism

et al. 2018

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“…They found excellent correlation between both assays and because of its accuracy it permits a reduction of operating time [11]. In a short-term study, Zhang et al [4] evaluated the diagnostic accuracy of ioPTH in predicting successful PTX in 501 secondary HPT patients. In 89% or more of cases, ioPTH could predict successful PTX with a sensitivity rate of 78.6% and specificity rate of 88.5%.…”

Section: Discussionmentioning

confidence: 99%

“…Moor et al[15] showed that after PTX, patients are required to have long-term calcium and PTH assay follow-up because of tenacious hypoparathyroidism, as normoparathyroidism cannot be achieved. Zhang et al[4] defined successful PTX as iPTH <300 pg/mL after PTX. Overall, the mean percentage reduction of serum iPTH at 10 and 20 min after PTX in the successful PTX group were 86.8 and 90.6%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…However, they defined cure as a condition where there was no need for another PTX even if patients left the hospital with severe hypoparathyroidism. Zhang et al[4], defined successful PTX as iPTH <300 pg/mL after PTX. Overall, the mean percentage reduction of serum iPTH at 10 and 20 min after PTX in the successful PTX group were 86.8 and 90.6% respectively.…”

Section: Introductionmentioning

confidence: 99%

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Value of Intraoperative Parathyroid Hormone Assay during Parathyroidectomy in Dialysis and Renal Transplant Patients with Secondary and Tertiary Hyperparathyroidism

El-Husseini

Wang

Edon

et al. 2017

Nephron

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Background: In dialysis and renal transplant patients with secondary and tertiary hyperparathyroidism (HPT), the value of intraoperative parathyroid hormone (ioPTH) during parathyroidectomy (PTX) and its association with long-term PTH levels are unknown. The present study aims at evaluating the relationship of ioPTH with long-term PTH levels post-PTX in dialysis and renal transplant patients in a single-center study. Methods: The ioPTH was measured in 57 dialysis patients (33 females and 24 males) and 18 renal transplant recipients (12 males and 6 females) who underwent PTX from 2005 to 2015 for refractory HPT. Near-total PTX was performed in 56 patients and total PTX with autotransplantation in 20 patients. The PTH monitoring included 3 samples: pre-intubation, 10- and 20-min (pre-ioPTH, 10-ioPTH, and 20-ioPTH) post parathyroid gland excision. Patients were followed up for up to 5 years. Results: In the dialysis group, the median (25th–75th percentile) pre-, 10-, and 20-ioPTH levels were 1,447 pg/mL (938–2,176), 143 pg/mL (78–244) and 112 pg/mL (59–153) respectively. In the renal transplant group, pre-, 10-, and 20-ioPTH levels were 273 pg/mL (180–403), 42 pg/mL (25–72), and 34 pg/mL (23–45) respectively. All patients in the transplant group had a functional kidney transplant at the time of PTX with a median serum creatinine of 1.3 mg/dL (1.2–1.7) and estimated glomerular filtration rate of 55 mL/min (40–60). The median time between renal transplant and PTX surgeries was 22 months (7–81). The last median follow-up PTH level was 66 pg/mL (15–201) in the dialysis group and 54 pg/mL (17–72) in the transplant group (p = 0.438). The mean time for last PTH post-PTX was 2.3 ± 2.0 years. In both groups, there was no significant difference between 20-ioPTH and any-time post-PTX PTH levels (p = 0.6 and p = 0.9). Nineteen patients (25%) were readmitted within 90 days because of hypocalcemia. One patient in the dialysis group was readmitted for post-PTX hematoma evacuation. No patient required repeat PTX because of recurrent HPT that was refractory to medical therapy. Only one dialysis patient required repeat PTX because the first procedure failed. Conclusions: The 20-ioPTH is a good indicator of long-term PTH levels in dialysis and renal transplant patients. Hypocalcemia is a common complication, particularly in dialysis patients, and it is the main reason for readmission after PTX. Hypoparathyroidism is a potential concern after PTX in dialysis patients.

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Study on the correlation between mineral bone metabolism and CRP in patients with SHPT during perioperative period

Liang

Xiong

et al. 2023

Immunity Inflam & Disease

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Objective This study mainly observes changes in perioperative mineral bone metabolism‐related indicators and inflammatory factors in patients with secondary hyperparathyroidism (SHPT), and analyzed the correlation between mineral bone metabolism‐related indicators and inflammatory factors. Methods Clinical data were collected. The study detects mineral bone metabolism‐related indicators and inflammatory factor of perioperative patients with SHPT before and 4 days after operation. The production of high‐sensitivity c‐reactive protein (hs‐CRP) in human hepatocytes cells (LO2 cells) stimulated by different concentrations of parathyroid hormone‐associated protein was detected by enzyme‐linked immunosorbent assay, reverse‐transcription polymerase chain reaction (RT‐PCR), and western blot. Results The levels of mineral bone metabolism‐related indicators and hs‐CRP in SHPT group were significantly higher than those of control group. After operation, serum calcium, serum phosphorus, iPTH, FGF‐23 decreased, and the level of osteoblast active biomarkers increased, while the level of osteoclast active biomarkers decreased. The levels of hs‐CRP decreased significantly after operation. With the increase of PTHrP concentration, hs‐CRP level in supernatant of LO2 cells decreased first and then increased. RT‐PCR and western blot shows the same trend. Conclusion Parathyroidectomy can significantly improve bone resorption and inflammation in SHPT patients. We speculate that there may be an optimal range of PTH concentrations to minimize inflammation in the body.

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Diagnostic Accuracy Study of Intraoperative and Perioperative Serum Intact PTH Level for Successful Parathyroidectomy in 501 Secondary Hyperparathyroidism Patients

Cited by 49 publications

References 22 publications

Sixty‐Two‐Year‐Old Male Suffering From Uremic Leontiasis Ossea Caused by Severe Secondary Hyperparathyroidism

Sixty‐Two‐Year‐Old Male Suffering From Uremic Leontiasis Ossea Caused by Severe Secondary Hyperparathyroidism

Value of Intraoperative Parathyroid Hormone Assay during Parathyroidectomy in Dialysis and Renal Transplant Patients with Secondary and Tertiary Hyperparathyroidism

Study on the correlation between mineral bone metabolism and CRP in patients with SHPT during perioperative period

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