Intraoperative parathyroid hormone monitoring fails to detect double parathyroid adenomas: A 2-institution experience

Gauger, Paul G.; Agarwal, Gaurav; England, Barry G.; Delbridge, Leigh; Matz, Keith A.; Wilkinson, M. C.; Robinson, Bruce G.; Thompson, Norman W.

doi:10.1067/msy.2001.118385

Cited by 159 publications

(139 citation statements)

References 10 publications

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“…IOPTH levels may fall to a reassuring degree even in patients with remaining abnormal glands only for patients to present again later with hypercalcaemia. 23,24 The commonly accepted reduction in IOPTH levels (>50%) may lead to missed adenomas or hyperplastic disease. 25 Analysis of postoperative PTH data concluded that the use of IOPTH measurements would only raise the cure rate by 1% at best.…”

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confidence: 99%

Simplified minimally invasive parathyroidectomy: a series of 100 cases and review of the literature

Wong

et al. 2011

annals

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Primary hyperparathyroidism (PHPT) is defined as symptomatic hypercalcaemia due to excessive parathyroid hormone (PTH) secretion in the absence of secondary or tertiary causes. Surgical management involves parathyroidectomy, which has shown to improve health-related quality of life.1 Conventional surgical practice has been collar incision with bilateral neck exploration and a four-gland evaluation approach.From the early 21st century, minimally invasive techniques of unilateral exploration and evaluation limited to the site of suspected lesion, as directed by preoperative localisation, were developed.2 These include video-assisted parathyroidectomy, endoscopic parathyroidectomy and mini-incision parathyroidectomy.Minimally invasive parathyroidectomy (MIP) showed a lower complication rate, with a reduced hospital stay and cost compared with the conventional approach.3 However, a national survey in the UK and Ireland noted that only 3% of consultant members of the British Association of Endocrine Surgeons were using the lateral incision approach, with the majority preferring the collar incision. 4 Some centres use intraoperative parathyroid hormone (IOPTH) measurements as routine 5 although the role of the IOPTH in parathyroidectomy at this point is questionable. 6Frozen sections are also used occasionally in parathyroid surgery to identify parathyroid tissue and differentiate it from non-parathyroid tissue with good accuracy. 7Our local practice utilises simplified parathyroidectomy. This involves a mini-incision without the routine use of IOPTH measurements and frozen sections. This study aims to demonstrate that a good success rate can be achieved without the use of any intraoperative adjuncts. This simplified technique will hopefully encourage more to undertake minimally invasive parathyroid surgery. Materials and MethodsThe first 100 patients who underwent MIP for PHPT from January 2008 done at a single institution by a single surgeon were recruited prospectively for this study. Preoperatively, patients underwent ultrasonography (US) and/or a 99m Tc-labelled sestamibi (MIBI) scan for localisation. The risks were ABSTRACT inTRodUCTion Conventional practice of parathyroidectomy has been collar incision with bilateral neck exploration and a fourgland evaluation. our local practice involves simplified parathyroidectomy via mini-incision without routine use of intraoperative adjuncts. The aim of this study is to demonstrate that a good success rate can be achieved, which will hopefully encourage more to undertake minimally invasive parathyroid surgery. maTERiaLS and mEThodS a prospective case series of the first 100 patients undergoing minimally invasive parathyroidectomy (miP) by a single surgeon at a single institution were included. Preoperatively, patients underwent ultrasonography (US) and/or a sestamibi (mibi) scan for localisation. Parathyroidectomy was performed following an algorithm of intraoperative decisions. Serum calcium and/or parathyroid hormone levels were checked at follow-up. Postoperative normo...

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confidence: 99%

Simplified minimally invasive parathyroidectomy: a series of 100 cases and review of the literature

Wong

et al. 2011

annals

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“…Another study reported that the assay has also been able to predict severe postoperative hypocalcaemia in reoperative patients with multiglandular disease [25]. However, in a small number of reports, it has been suggested that intraoperative PTH monitoring does not significantly benefit the overall success rate of traditional surgery with bilateral neck exploration when it does not accurately detect the presence of double adenomas [26,27]. This assay is not intended to replace, but to complement and provide guidance for the judgment and experience of the surgeon to determine surgical cure.…”

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confidence: 99%

Feasibility of Rapid Parathormone Assay for Enabling Minimally Invasive Parathyroid Excision

2012

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There is no doubt that the success of minimally invasive parathyroidectomy (MIP) has changed the whole treatment of patients with primary hyperparathyroidism, especially the approach towards traditional bilateral neck exploration. A single adenoma is the most common cause of primary hyperparathyroidism and its removal results in cure. Hence, it is worth the effort to localise and excise the single adenoma using modern technologies such as highquality sestamibi scans and to confirm complete excision using rapid intra operative parathormone (IOPTH) assays. The objective of the study was to evaluate the feasibility of rapid IOPTH assay in successfully facilitating minimally invasive parathyroid excision. This research involved the retrospective study of seven patients, who underwent MIP at Sagar Hospital in Bengaluru, India, for parathyroid adenoma. All patients with evidence of unifocal disease on sestamibi scanning and cervical ultrasonography, underwent MIP via 2-3 cm lateral incision. Blood samples for measurement of IOPTH were taken at the time of induction of anaesthesia and 10 min after the adenoma excision. Reduction of parathormone (PTH) levels of more than 50 % in the postexcision sample was taken as evidence for complete extirpation of parathyroid adenoma. A solitary adenoma was identified in all the seven patients. After MIP, IOPTH levels fell in six of the seven patients.Following the surgery, all the cases were followed up for a period of 1 month. During this time, except for one patient, six patients remained asymptomatic and blood tests revealed normal serum calcium levels. A histopathological examination confirmed the diagnosis of parathyroid adenoma in six of the seven patients. After accurate preoperative localisation of the adenoma in patients with primary hyperparathyroidism, MIP with IOPTH measurement offers a safe and successful outcome.

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“…23 According to the Miami criteria, 24 a 50% decrease in PTH levels 10 minutes after removal of the putative lesion suggests a curative operation. However, the assay might sometimes yield inaccurate results, [25][26][27][28] as when PTH concentrations may decrease even in the presence of MGD. IOPTH monitoring might also wrongly lead to a bilateral operation.…”

Section: Discussionmentioning

confidence: 99%

High-resolution magic angle spinning 1H nuclear magnetic resonance spectroscopy metabolomics of hyperfunctioning parathyroid glands

Battini

Impériale

Taïeb

et al. 2016

Surgery

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Intraoperative parathyroid hormone monitoring fails to detect double parathyroid adenomas: A 2-institution experience

Cited by 159 publications

References 10 publications

Simplified minimally invasive parathyroidectomy: a series of 100 cases and review of the literature

Simplified minimally invasive parathyroidectomy: a series of 100 cases and review of the literature

Feasibility of Rapid Parathormone Assay for Enabling Minimally Invasive Parathyroid Excision

High-resolution magic angle spinning 1H nuclear magnetic resonance spectroscopy metabolomics of hyperfunctioning parathyroid glands

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