Intraoperative Parathyroid Hormone Measurement in Patients With Secondary Hyperparathyroidism

Chou, Fong‐Fu; Lee, Chiang Hsuen; Chen, Jin Bor; Hsu, Kuo Tai; Sheen-Chen, Shyr Ming

doi:10.1001/archsurg.137.3.341

Cited by 72 publications

(72 citation statements)

References 15 publications

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“…The quick intraoperative parathormone assay (qPTH) has proven its reliability and applicability as a predictor of successful surgical treatment of primary and secondary HPT (20,21). The qPTH can accurately facilitate unilateral, directed neck exploration for uniglandular PTG disease, as well as guide the extent of gland resection for multiglandular disease (22).…”

Section: Discussionmentioning

confidence: 99%

Kinetics of intraoperative fluorescence diagnosis of parathyroid glands

Prosst

Schroeter

Gahlen

2004

European Journal of Endocrinology

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Objective: Identification of parathyroid glands is often a challenge even for experienced surgeons. The feasibility and efficacy of fluorescence diagnosis for localization of parathyroids has already been proven in an experimental setting. In preparation for a clinical application of this technique in patients undergoing surgery for hyperparathyroidism, we evaluated the kinetics of fluorescence diagnosis. Design and methods: Fifty rats were randomized into eight groups with different photosensitization parameters using the photosensitizer aminolevulinic acid (ALA): a peritoneal lavage was performed with either 1.5 or 3.0% ALA solution and the induced photosensitization times varied from 0.5, 1 and 2 to 4 h. Under special fluorescence illumination, D-light, the exposed operative site with thyroid, parathyroid glands and neck muscles was examined. The identified parathyroid glands were studied according to fluorescence intensity by spectrometric measurement and compared with surrounding tissue.Results: Photosensitizer accumulation in parathyroid glands, indirectly measured by spectrometry, was up to 3.2 times higher than in thyroid and 2.6 times higher than in muscle tissue (2 h photosensitization with 3.0% ALA). Using 1.5% ALA, the optimum fluorescence intensity and ratio/contrast was slightly lower (parathyroid-to-thyroid ratio £ 3.0, parathyroid-to-muscle ratio £ 1.9) but was reached earlier (1 h) and hence considered as the parameter of choice for a clinical application. Conclusions: In future clinical application, intraoperative fluorescence diagnosis is expected to increase the ease of identification of atypically located or supernumeric glands. In combination with preoperative diagnostics, this may result in reduced operation time and avoidance of persistent hypercalcaemia.European Journal of Endocrinology 150 743-747

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Section: Discussionmentioning

confidence: 99%

Kinetics of intraoperative fluorescence diagnosis of parathyroid glands

Prosst

Schroeter

Gahlen

2004

European Journal of Endocrinology

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“…Cure rates of Ͼ95% have been reported in several studies (7,29,32,49,50 ), including one study with up to 5 years of follow-up (51 ). In addition, the rapid PTH assay has been shown to be useful in cases of secondary-tertiary hyperparathyroidism (32,39,52 ), as well as in reoperative cases for failed surgery or recurrent disease (32,45,53,54 ). The assay has also been reported to predict severe postoperative hypocalcemia in reoperative patients with multiglandular disease (55 ).…”

Section: Clinical Utility Of Rapid Intraoperative Pth Testsmentioning

confidence: 99%

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

2004

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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-

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“…This advantage does not always mean better patient outcomes, the medical unit that would like to perform POCT should be interested in the real impact of results in clinical practice, besides the accuracy of devices. Kendal et al [1] [13] 2000 Prospective USA 1788 NR Borgard [14] 2006 Prospective France 473 NR Engle [15] 2002 Prospective USA 404 NR Ho [16] 2006 Prospective China 4689 SN, SP, PPV, NPV Kazmierczak [17] 2004 Prospective USA Unclear NR Lam [18] 2008 Prospective China 113 SN, SP Maisels [19] 2004 Prospective USA 849 NR Mielsch [20] 2010 Prospective Germany 240 NR Robertson [21] 2002 Prospective USA 101 NR Rolinski [22] 2001 Prospective Germany 142 NR Rubaltelli [23] 2001 Prospective Italy NR NR Schmidt [24] 2009 Cohort USA 94 SN, SP, NPV Schumacher [25] 1995 Prospective USA NR NR Tan [26] 1996 Prospective Singapore 540 NR Tayaba [27] 1998 Prospective USA 900 NR Wong [28] 2002 Prospective UK 64 PPV Yamanouchi [29] 1980 Prospective Japan NR NR Yamauchi [30] 1988 Prospective Japan 576 NR Procalcitonin Bektas [31] 2011 Prospective Turkey 141 SN, SP, LR+, LRGaletto-Lacour [32] 2003 Prospective Switzerland 99 SN, SP, PPV, NPV Hesselink [33] 2009 Prospective Netherlands 101 NR Meisner [34] 2000 Prospective Germany 237 NR PTH Agarwal [35] 2001 Prospective Australia 88 NR Chou [36] 2002 Case series Taiwan NR NR Garner [37] 1999 Prospective NC 130 NR Johnson [38] 2001 Prospective USA 104 NR Mace [39] 2008 Prospective UK 20 NR Sokoll [40] 2000 Prospective USA 200 NR Troponin Apple [41] 2000 Prospective USA 1550 SN, SP Apple [42] 2006 Observational retrospective USA 545 NR Birkhahn [43] 2010 Prospective USA 151 SN, SP, PPV, NPV Bock [44] 2008 Prospective US...…”

Section: Discussionmentioning

confidence: 99%

“…Only one [38] out of six studies about PTH evaluated reduction on TAT and LOS. The study of Chou et al [36] reported numbers of re-interventions (two patients had a secondary operation) and surgery complications. The majority of studies considered 'important patient outcome' is in the Tn group: eight out of 25 studies (32%) evaluated reduction on LOS, of these seven considered also TAT.…”

Section: Patient Important Outcomesmentioning

confidence: 99%

Point-of-care testing: where is the evidence? A systematic survey

Pecoraro

Germagnoli

Banfi

2013

Clinical Chemistry and Laboratory Medicine (CCLM)

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Point-of-care testing (POCT) has had rapid techno logical development and their use is widespread in clinical laboratories to assure reduction of turn-aroundtime and rapid patient management in some clinical settings where it is important to make quick decisions. Until now the papers published about the POCT have focused on the reliability of the technology used and their analy tical accuracy. We aim to perform a systematic survey of the evidence of POCT efficacy focused on clinical outcomes, selecting POCT denoted special analytes characterized by possible high clinical impact. We searched in Medline and Embase. Two independent reviewers assessed the eligibility, extracted study details and assessed the methodological quality of studies. We analyzed 84 studies for five POCT instruments: neonatal bilirubin, procalcitonin, intra-operative parathyroid hormone, troponin and blood gas analysis. Studies were at high risk of bias. Most of the papers (50%) were studies of correlation between the results obtained by using POCT instruments and those obtained by using laboratory instruments. These data showed a satisfactory correlation between methods when similar analytical reactions were used. Only 13% of the studies evaluated the impact of POCT on clinical practice. POCT decreases the time elapsed for making decisions on patient management but the clinical outcomes have never been adequately evaluated. Our work shows that, although POCT has the potential to provide beneficial patient outcome, further studies may be required, especially for defining its real utility on clinical decision making.

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Intraoperative Parathyroid Hormone Measurement in Patients With Secondary Hyperparathyroidism

Abstract: Secondary hyperparathyroidism decreases renal clearance of parathyroid hormone (PTH). Objective: To determine whether rapid PTH assays can be used to predict the success of a total parathyroidectomy to treat symptomatic secondary hyperparathyroidism.

Cited by 72 publications

References 15 publications

Kinetics of intraoperative fluorescence diagnosis of parathyroid glands

Kinetics of intraoperative fluorescence diagnosis of parathyroid glands

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

Point-of-care testing: where is the evidence? A systematic survey

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