Predictive value of intact parathyroid hormone measurement during surgery for renal hyperparathyroidism

Seehofer, Daniel; Rayes, Nada; Klupp, J; Steinmüller, Thomas; Ulrich, Frank; Müller, Christian; Schindler, R; Frei, Ulrich

doi:10.1007/s00423-005-0541-z

Cited by 34 publications

(39 citation statements)

References 27 publications

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“…Moreover, the increased PTH half-life (whole and fragments) seen in renal insufficiency [18,19,30] makes it difficult to achieve a significant and reproducible decrease in a reasonable amount of time. Different criteria for cure have been proposed for IOPTH in renal hyperparathyroidism such as >50% decrease at 20 min [18], >82% at 15 min [20], or >60% at 10 min [19]. However, none of them could predict cure or failure in 100% of the patients.…”

Section: Discussionmentioning

confidence: 99%

“…If IOPTH has the same sensitivity and specificity in tertiary HPT, it could help define the extent of parathyroidectomy. The accuracy of IOPTH in renal HPT is not clearly described and different authors have described conflicting results [18][19][20]. Moreover, many papers describe IOPTH independently of the renal function (in patients under dialysis and patients after kidney transplantation) [18,20] and few have focused their attention on patients with tertiary HPT after kidney transplantation.…”

Section: Introductionmentioning

confidence: 99%

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Accuracy of intra-operative PTH measurement during subtotal parathyroidectomy for tertiary hyperparathyroidism after renal transplantation

Triponez

Dosseh²,

Hazzan³

et al. 2006

Langenbecks Arch Surg

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Background and aims Intra-operative parathyroid hormone (IOPTH) results are not known in the setting of tertiary hyperparathyroidism (HPT) after renal transplantation. Materials and methods A retrospective analysis of 35 tertiary HPT patients who all underwent subtotal parathyroidectomy and IOPTH monitoring was conducted.Results The mean follow-up time was 2.2±1.4 years. Thirty-four patients were cured; one patient (2.8%) had a persistent disease and was cured after reoperation. Median parathyroid hormone (PTH) (median percent decrease from highest) at baseline and at 5, 10, 20, and 30 min were 244, 78 (69%), 63 (75%), 53 (79%), and 49 pg/ml (83%), respectively. Four patients who were cured had a decrease of <50% at 5 min and two of them had a decrease of <50% at 10 min. The patient with persistent disease had a decrease of >50% at 10 min. The sensitivity of the test was 94% at 10 min using the Miami criteria. Conclusion This study shows that IOPTH in tertiary hyperparathyroidism has a high sensitivity. However, because of the low risk of persistent hyperparathyroidism when a subtotal parathyroidectomy is performed, its potential impact on the overall success rate is very small. We therefore do not recommend the routine use of IOPTH in tertiary hyperparathyroidism.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Accuracy of intra-operative PTH measurement during subtotal parathyroidectomy for tertiary hyperparathyroidism after renal transplantation

Triponez

Dosseh²,

Hazzan³

et al. 2006

Langenbecks Arch Surg

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“…Patients were comparable regarding age, sex, and levels of preoperative iPTH, vitamin D, serum calcium, phosphate, alkaline phosphatase, and creatinine and the glomerular filtration rate ( . In 1 patient of group 2, the criterion of successful surgery, 15 an iPTH level of less than 150 pg/mL or less than 30% of the baseline level, was not fulfilled. On the second day after parathyroidectomy, all patients in group 1 had undetectable iPTH levels.…”

Section: General Data and Perioperative Ipth Levelsmentioning

confidence: 96%

Long-term Results of Subtotal vs Total Parathyroidectomy Without Autotransplantation in Kidney Transplant Recipients

Rayes

Seehofer²,

Schindler³

et al. 2008

Arch Surg

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Total parathyroidectomy without autotransplantation in kidney transplant recipients leads to reduced recurrence rates and similar improvement of clinical symptoms compared with subtotal parathyroidectomy.Design: A retrospective cohort study.Setting: University clinic.Patients: Thirty-three patients with functioning renal grafts who underwent primary total (n = 17; group 1) or subtotal (n = 16; group 2) parathyroidectomy for renal hyperparathyroidism.Main Outcome Measures: Long-term levels of intact parathyroid hormone, serum calcium, phosphate, alkaline phosphatase, creatinine, and vitamin D; bone pain; use of medication; and incidence of persistent or recurrent hyperparathyroidism. Results:The mean length of follow-up was 31 months in group 1 and 41 months in group 2. In all patients, post-operative serum calcium and phosphate levels normalized and bone pain markedly decreased. Persistent hypocalcemia was not observed. Serum creatinine levels intermittently increased in both groups but returned to preoperative levels in most of the patients. In group 1, all patients had undetectable intact parathyroid hormone levels throughout the study period. In group 2, 2 patients had persistent and 3 patients developed recurrent hyperparathyroidism (31%) that required therapy with cinacalcet hydrochloride in 3 cases. In 4 of these 5 patients, intact parathyroid hormone levels were greater than 54 ng/L directly after operation. In all, 27 of 33 patients (82%) received cholecalciferol therapy. Additional calcium supplementation was used by 12 group 1 patients (71%) and 3 group 2 patients (19%).Conclusions: Total parathyroidectomy in kidney transplant recipients appears to be safe and protective against persistent and recurrent disease. If subtotal parathyroidectomy is performed, the remnant should be small.

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“…Several studies report that a significant reduction in IOPTH levels compared to preoperative levels is highly predictive of postoperative success. Additionally, IOPTH is regarded by some as a valuable tool in intraoperative decision-making and to discern patients with both supernumerary, ectopic and fewer than four parathyroid glands removed [25,[80][81][82][83] (EL 1b-3). In sharp contrast, other authors consider IOPTH of no or limited practical utility.…”

Section: Surgery With and Without Utilization Of Intraoperative Paratmentioning

confidence: 99%

Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons

Lorenz

Bartsch

Sancho

et al. 2015

Langenbecks Arch Surg

100

130

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Background Despite advances in the medical management of secondary hyperparathyroidism due to chronic renal failure and dialysis (renal hyperparathyroidism), parathyroid surgery remains an important treatment option in the spectrum of the disease. Patients with severe and complicated renal hyperparathyroidism (HPT), refractory or intolerant to medical therapy and patients with specific requirements in prospect of or excluded from renal transplantation may require parathyroidectomy for renal hyperparathyroidism. Methods Present standard and actual controversial issues regarding surgical treatment of patients with hyperparathyroidism due to chronic renal failure were identified, and pertinent literature was searched and reviewed. Whenever applicable, evaluation of the level of evidence concerning diagnosis and management of renal hyperparathyroidism according to standard criteria and recommendation grading were employed. Results were discussed at the 6th Workshop of the European Society of Endocrine Surgeons entitled Hyperparathyroidism due to multiple gland disease: An evidence-based perspective.Results Presently, literature reveals scant data, especially, no prospective randomized studies to provide sufficient levels of evidence to substantiate recommendations for surgery in renal hyperparathyroidism. Appropriate surgical management of renal hyperparathyroidism involves standard bilateral exploration with bilateral cervical thymectomy and a spectrum of four standardized types of parathyroid resection that reveal comparable outcome results with regard to levels of evidence and recommendation. Specific patient requirements may favour one over the other procedure according to individualized demands. Conclusions Surgery for patients with renal hyperparathyroidism in the era of calcimimetics continues to play an important role in selected patients and achieves efficient control of hyperparathyroidism. The overall success rate and longterm control of renal hyperparathyroidism and optimal handling of postoperative metabolic effects also depend on the timely indication, individually suitable type of parathyroid resection and specialized endocrine surgery.

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Predictive value of intact parathyroid hormone measurement during surgery for renal hyperparathyroidism

Cited by 34 publications

References 27 publications

Accuracy of intra-operative PTH measurement during subtotal parathyroidectomy for tertiary hyperparathyroidism after renal transplantation

Accuracy of intra-operative PTH measurement during subtotal parathyroidectomy for tertiary hyperparathyroidism after renal transplantation

Long-term Results of Subtotal vs Total Parathyroidectomy Without Autotransplantation in Kidney Transplant Recipients

Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons

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