Quick PTH assay cannot predict incomplete parathyroidectomy in patients with renal hyperparathyroidism

Kaczirek, Klaus; Riss, Philipp; Wunderer, Gerald; Prager, Gerhard; Asari, Reza; Scheuba, Christian; Bieglmayer, Christian; Niederle, Bruno

doi:10.1016/j.surg.2004.12.017

Cited by 43 publications

(42 citation statements)

References 15 publications

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“…Postoperative outcomes relative to iPTH-R concentrations obtained within the first postoperative week (Table 1) showed that persistent HPT (PTH concentrations Ͼ3-fold higher than the upper limit of the reference interval plus hypercalcemia within the first 6 months after surgery) occurred in all 5 of 32 patients classified as "insufficient PTX" based on increased iPTH-R result. In all cases, persistent HPT was caused by parathyroid tissue left in the neck (15 ), whereas the 6-month follow-up revealed cure in 27 of 32 patients. iPTH-R concentrations below or within the reference interval several days after surgery suggested that in all cured patients, sufficient PTX had been achieved by either total or subtotal resections.…”

Section: Resultsmentioning

confidence: 87%

“…In minimally invasive surgery for primary HPT, the criterion of a decrease in iPTH-R to Ͻ50% of baseline within 10 min after resection is helpful in differentiating between singleand multiple-gland disease (17 ). In contrast, in rHPT, the iPTH-R values cannot be used to guide the exploration (15 ). The intraoperative laboratory data and plasma sample aliquots were collected only for retrospective analyses in rHPT.…”

Section: Pth Immunoassays and Other Laboratory Methodsmentioning

confidence: 99%

“…Intraoperative monitoring of PTH may be helpful to confirm total PTX for treatment of rHPT, but iPTH assays often fail to predict total PTX in patients with rHPT (7,15 ). We compared two 2nd-generation iPTH assays with a 3rd-generation PTH(1-84) assay, evaluated the influence of renal function on kinetic data of PTH clearance, and calculated the sensitivity and specificity of the assays, the 3rd-generation assay in particular, in predicting surgical success from intraoperative data.…”

Section: Parathyroid Hormone Is An 84 -Amino Acid Polypeptide [Pth(1-mentioning

confidence: 99%

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Parathyroid Hormone Monitoring during Total Parathyroidectomy for Renal Hyperparathyroidism: Pilot Study of the Impact of Renal Function and Assay Specificity

et al. 2006

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Background: Commonly used assays for intact parathyroid hormone (iPTH) detect not only the biologically active 84 -amino acid hormone [PTH(1-84)], but crossreact with an N-terminal-truncated fragment. Because iPTH assays often fail to predict success of parathyroidectomy in patients with renal hyperparathyroidism (rHPT), we compared results of a 3rd-generation PTH(1-84) assay (Bio-iPTH; Nichols Institute Diagnostics) with two 2nd-generation iPTH assays (from Nichols and Roche Diagnostics) by evaluating the PTH clearance kinetics during surgical treatment. Methods: We collected blood samples in short time intervals from 35 consecutive surgical patients with rHPT. Three patients had to be excluded from further calculations; the remainder were grouped according to kidney function and postoperative outcome. All samples were analyzed with the 3 automated PTH assays, which have different specificities. Results: Twenty minutes after removal of the last gland, the PTH(1-84) values decreased to within the reference intervals in all patients with total and subtotal resection; however, iPTH concentrations normalized in only one half of these patients. In patients with poor renal function, the half-life of PTH(1-84) was shorter than the half-lives obtained with the iPTH assays. Conclusions: The accuracy of PTH monitoring during surgery for rHPT depends on renal function and assay specificity. All assays tested showed similar effective-

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Section: Resultsmentioning

confidence: 87%

Section: Pth Immunoassays and Other Laboratory Methodsmentioning

confidence: 99%

Section: Parathyroid Hormone Is An 84 -Amino Acid Polypeptide [Pth(1-mentioning

confidence: 99%

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Parathyroid Hormone Monitoring during Total Parathyroidectomy for Renal Hyperparathyroidism: Pilot Study of the Impact of Renal Function and Assay Specificity

et al. 2006

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“…The level of intact parathormone obtained, served as a baseline level, as recommended by Irvin et al (2004) and Kaczirek et al (2005). Second blood sample was taken 10 minutes after the pathologic parathyroid gland was removed.…”

Section: Methodsmentioning

confidence: 99%

Measurement of intact parathormone during operation for primary hyperparathyroidism

Libánský¹,

Adámek²,

Broulík³

et al. 2017

BLL

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In this prospective study, the role of the intact parathormone (iPHT) levels for the verifi cation of pathologic parathyroid tissue removal during parathyroidectomy, was analyzed in 441 patients diagnosed with primary hyperparathyroidism. The level of intact parathormone was obtained before the initial incision (baseline level) and 10 minutes after the pathologic parathyroid gland removal (control value). In 80 % of cases, the decrease of intact parathormone was more than 50 % of the baseline level. The comparison of preoperative and postoperative intact parathormone levels can also be used as marker of parathyroid hyperplasia or persistent hyperparathyroidism. This method is necessary mainly for performance of focused, miniinvasive approaches as well as in reoperations. This method is of signifi cant benefi t in cases of negative preoperative examination methods. The determination of intact parathormone level increases the success of parathyroidectomy (Ref. 26). Text in PDF www.elis.sk.

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“…According to Roshan et al [6], in the same sample of patients where the biochemical resolution of SHPT was correctly predicted by the use of intraoperative PTH assay, the same failed to predict a persistent hypoparathyroidism, thus revealing an arguable efficacy. All the same, many other studies involving this aspect are not at all concordant in the interpretation of their results and the possible advantages of the tool in patients with SHPT [9,10], whereas the results appear far more concordant for the treatment of patients with tertiary HPT after a successful renal transplantation.…”

mentioning

confidence: 94%

Intraoperative parathyroid hormone assay during surgery for secondary hyperparathyroidism: is it time to give up the chase at the hormone?

Miccoli

2012

Endocrine

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Quick PTH assay cannot predict incomplete parathyroidectomy in patients with renal hyperparathyroidism

Cited by 43 publications

References 15 publications

Parathyroid Hormone Monitoring during Total Parathyroidectomy for Renal Hyperparathyroidism: Pilot Study of the Impact of Renal Function and Assay Specificity

Parathyroid Hormone Monitoring during Total Parathyroidectomy for Renal Hyperparathyroidism: Pilot Study of the Impact of Renal Function and Assay Specificity

Measurement of intact parathormone during operation for primary hyperparathyroidism

Intraoperative parathyroid hormone assay during surgery for secondary hyperparathyroidism: is it time to give up the chase at the hormone?

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