Localization of Parathyroid Adenomas by Selective Venous Catheterization and Radioimmunoassay

Reitz, Richard E.; Pollard, James J.; Wang, Chiu-an; Fleischli, Donald J.; Cope, Oliver; Murray, Timothy M.; Deftos, Leonard J.; Potts, John T.

doi:10.1056/nejm196908142810704

Cited by 93 publications

(14 citation statements)

References 7 publications

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“…On the other hand, the abnormally high levels of extracellular ionized calcium suppress the synthesis and release of PTH into the bloodstream in other normal parathyroid glands. Therefore, the difference between the adenoma-side internal jugular sample and the contralateral side is useful clinically to localize the hyperfunctioning adenoma before (19) or during operation (20,21). In this study, samples from the bi-lateral internal jugular as well as peripheral samples were measured for iPTH, whole PTH and the large C-PTH levels.…”

Section: Discussionmentioning

confidence: 99%

Large carboxy-terminal parathyroid hormone (PTH) fragment with a relatively longer half-life than 1-84 PTH is secreted directly from the parathyroid gland in humans

Yamashita

Gao²,

Cantor³

et al. 2003

European Journal of Endocrinology

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Objective: It was discovered that an immunoreactive large carboxy-terminal parathyroid hormone (PTH) fragment (large C-PTH), likely 7-84 PTH, is present in the circulation. However, very little is known about the production and metabolism of this large C-PTH. Combining a whole molecule PTH (whole PTH) immunoradiometric assay (IRMA) specifically for 1-84 PTH and an intact PTH (iPTH) IRMA for the sum of 1-84 PTH and large C-PTH, we were able to assess the circulating level of this large C-PTH as well as the glandular secretion and metabolism of this large C-PTH in primary hyperparathyroidism (pHPT). Methods: This study consisted of two patient groups consisting of 77 pHPT patients with a single adenoma. Of these, 43 comprised the venous sampling study group and 70 comprised the intra-operative PTH study group. (Seven patients belonged only to the former group, 34 patients to only the latter group, and 36 patients to both groups.) Preoperatively, blood samples were drawn from the bilateral internal jugular vein by ultrasonographic guidance and from the peripheral vein (n ¼ 43). During surgery, blood samples were drawn after anesthesia (basal level), before excision (pre-excision level) of one enlarged parathyroid gland, and at 5, 10, and 15 min post-excision (n ¼ 70). Results: There were 26 patients whose iPTH assay levels differed by more than 10% between the right and left internal jugular. In 24 of the 26 patients, the large C-PTH levels obtained from the adenoma side were significantly higher than those from the contralateral side (117^135 vs 43^33 pg/ml, P , 0.001). The plasma whole PTH values decreased more rapidly than the iPTH values after parathyroidectomy (P , 0.001). Conclusions: Our study has demonstrated that the large C-PTH, likely 7-84 PTH, is directly released from the parathyroid gland in humans. Since the half-life of 1-84 PTH is much shorter than large C-PTH, likely 7-84 PTH, it would be advantageous to use an assay that specifically measures 1-84 PTH for intra-operative monitoring of parathyroidectomy.

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Section: Discussionmentioning

confidence: 99%

Large carboxy-terminal parathyroid hormone (PTH) fragment with a relatively longer half-life than 1-84 PTH is secreted directly from the parathyroid gland in humans

Yamashita

Gao²,

Cantor³

et al. 2003

European Journal of Endocrinology

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“…1969 (15). It may be useful when imaging studies are considered negative or discordant (16), and although the subclavian approach has been reported to be simpler, quicker, and less hazardous (17), it has not become the method of choice.…”

Section: Selective Venous Sampling (Svs) Is An Invasive Technique Firmentioning

confidence: 99%

Super-selective venous sampling in conjunction with quickPTH for patients with persistent primary hyperparathyroidism: report of five cases

Gimm

Arnesson²,

Olofsson³

et al. 2012

Surg Today

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“…Some of these conflicting reports may be due to either variations in methodology or perhaps are related to the relatively short half life of parathyroid hormone (Buckle, 1969). As well as estimations of parathyroid hormone concentration in peripheral blood, hormone concentrations have been determined in blood obtained at neck vein catheterisation in attempts to localise an adenoma prior to surgical exploration (Reitz et al, 1969).At the present time radioimmuno-assay remains a research procedure and although it offers great hope for the future it is not yet widely available.…”

Section: Parathyroid Hormone Assaymentioning

confidence: 99%

Laboratory Tests in the Differentiation of Hyperparathyroidism from other Causes of Hypercalcaemia

Wills

1970

Ann Clin Biochem

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Localization of Parathyroid Adenomas by Selective Venous Catheterization and Radioimmunoassay

Cited by 93 publications

References 7 publications

Large carboxy-terminal parathyroid hormone (PTH) fragment with a relatively longer half-life than 1-84 PTH is secreted directly from the parathyroid gland in humans

Large carboxy-terminal parathyroid hormone (PTH) fragment with a relatively longer half-life than 1-84 PTH is secreted directly from the parathyroid gland in humans

Super-selective venous sampling in conjunction with quickPTH for patients with persistent primary hyperparathyroidism: report of five cases

Laboratory Tests in the Differentiation of Hyperparathyroidism from other Causes of Hypercalcaemia

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