[Intraoperative parathyroid hormone measurement in patients with primary hyperparathyroidism; particularly valuable for suspected solitary parathyroid adenoma and re-operation].

Abstract

OBJECTIVE:

Analysis of the value of intraoperative parathormone (PTH) measurement in patients with primary hyperparathyroidism.

DESIGN:

Prospective study.

METHOD:

Evaluation of the value of intraoperative measurement ofPTH in 75 patients (including 19 patients with multiple endocrine neoplasia(MEN)-1 syndrome) who underwent parathyroidectomy in 2001-2005.

RESULTS:

The so-called Miami-criterion (PTH concentration 10 min after excision at least 50% below the value measured prior to the first incision) correctly predicted the success of the operation in 91% of the subjects. The success rate was correctly predicted as follows: in subgroups of patients with MEN-1 syndrome, 85%, patients after exclusion of MEN-1, 94%, and patients in whom a solitary adenoma was likely after preoperative localization studies, 97%. In 13% of the total number of operations, PTH-measurements led to further exploration, removal of additional parathyroid tissue and normocalcemia postoperatively. In patients without MEN-1 syndrome, in whom a solitary adenoma was likely on the basis of preoperative investigations, it was possible to limit the operation to a unilateral procedure in 87%.

CONCLUSION:

In the majority of patients with primary hyperparathyroidism, intraoperative PTH-measurement in combination with preoperative imaging studies leads to patients being cured with a unilateral instead of a bilateral operation.

• Authors: K Freriks, M den Heijer, J J Bonenkamp, J Biert, C G J Sweep, A R M M Hermus
• Journal: Nederlands tijdschrift voor geneeskunde (Ned Tijdschr Geneeskd) Vol. 152 Issue 1 Pg. 28-32 (Jan 05 2008) ISSN: 0028-2162 [Print] Netherlands
• Vernacular Title: Intraoperatieve bepaling van parathormoon bij primaire hyperparathyreoïdie; vooral waardevol bij vermoeden van solitair bijschildklieradenoom en bij heroperatie.
• PMID: 18240759 (Publication Type: English Abstract, Journal Article)

Chemical References

• Parathyroid Hormone

Topics

• Adenoma (surgery)
• Female
• Humans
• Hyperparathyroidism, Primary (blood)
• Male
• Middle Aged
• Monitoring, Intraoperative (methods)
• Parathyroid Hormone (blood)
• Parathyroid Neoplasms (surgery)
• Parathyroidectomy
• Treatment Outcome