Parathyroid Hormone Response to Tracheal Intubation in Hyperparathyroid Patients and Normal Subjects

Abstract

Abstract. The stress of direct laryngoscopy and passing an endotracheal tube through the vocal cords elicits haemodynamic, metabolic and hormonal changes such as raising blood catecholamine levels. Catecholamines are known stimulants of PTH secretion. The effect of tracheal intubation on plasma parathyroid hormone levels has not yet been investigated. We monitored changes in plasma parathyroid hormone levels before and after tracheal intubation in 72 hyperparathyroid patients undergoing elective parathyroidectomy for primary and secondary hyperparathyroidism. These findings were compared to data collected from 20 subjects who underwent elective surgery (thyroidectomy or laparoscopic cholecystectomy) under general anesthesia. In the control group, tracheal intubation significantly increased plasma parathyroid hormone levels from 59 ± 31 pg/ml to 91 ± 40 pg/ml (mean ± SD) (p<0.0003). In primary hyperparathyroid patients, the identical procedure increased plasma parathyroid hormone levels from 206 ± 104 pg/ml to 217 ± 113 pg/ml (p = 0.12) and from 898 ± 495 pg/ml to 1162 ± 613 pg/ml (p = 0.07) in secondary hyperparathyroidism patients. We concluded that tracheal intubation raises plasma parathyroid hormone levels. The mechanism underlying this response requires further investigation. THE physiologic response to tracheal intubation was investigated many years ago and we are now aware of rapid changes in blood levels of adrenalin, noradrenalin, cortisol, adrenocorticotropic hormone, aldosterone and thyroid hormone following this procedure [1][2][3][4]. These responses were attributed to the stress of direct laryngoscopy and passing the tube through the vocal cords [5][6][7]. Catecholamines are known stimulants of parathyroid hormone (PTH) secretion [8][9][10]. The effect of intubation on blood levels of PTH is unknown. Therefore, the purpose of this study was to establish whether there is a change in plasma PTH levels following tracheal intubation in patients with hyperparathyroidism and in individuals with normal parathyroid function. Except for understanding the endocrine physiology, it has a practical aspect, since intraoperative PTH level is essential for confirmation of all hyperfunctioning parathyroid tissue removal.

Effects of propofol on intraoperative parathyroid hormone monitoring in patients with primary hyperparathyroidism undergoing parathyroidectomy: a randomized control trial

“…The catecholamine surge that occurs in response to tracheal intubation 9,10 has been shown to stimulate the PTH secretion. 11 Mahajna et al 11 reported a large increase in serum PTH in patients with normal parathyroid function; however, only female patients with primary HPT experienced a modest albeit statistically significant increase in serum PTH, while this increase was not significant in patients with secondary HPT. This suggests that the rise in serum PTH induced by catecholamines in patients with primary or secondary HPT may be blunted.…”

“…Mahajna et al noted previously that only female subjects with primary HPT experienced increases in serum PTH concentrations with endotracheal intubation. 11 The possibility exists that there may be substantial differences between sexes in PTH responses to stress. Finally, we assessed the potential for in vitro interference by propofol using only one of several available rapid PTH assays.…”

Effect of general anesthesia and intubation on parathyroid levels in normal patients and those with hyperparathyroidism

“…A few studies have reported an elevation of blood PTH immediately after general anesthesia and endotracheal intubation in patients with primary HPT having parathyroidectomy. 19,20 Hong et al 19 reported an immediate blood PTH rise in patients with primary HPT undergoing parathyroidectomy using different anesthetic techniques (monitored anesthetic care, general anesthesia with a laryngeal mask, and general anesthesia and endotracheal intubation). They found that general anesthesia and endotracheal intubation, the most stress-baring procedure, has the greatest impact upon PTH elevation.…”

“…Moreover, various anesthetic agents were described to attenuate PTH blood levels . Yet, only a few studies reported general anesthesia and endotracheal intubation to modify PTH blood levels in patients presenting with primary HPT and undergoing parathyroidectomy . In addition, this phenomenon was not extensively investigated in patients with a normal parathyroid function.…”

“…[15][16][17][18] Yet, only a few studies reported general anesthesia and endotracheal intubation to modify This work was presented at the Annual Meeting of The Israeli Society of Otolaryngology, Head and Neck Surgery, Eilat, Israel, March 26-28, 2015. PTH blood levels in patients presenting with primary HPT and undergoing parathyroidectomy. 19,20 In addition, this phenomenon was not extensively investigated in patients with a normal parathyroid function.…”