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Measurement of parathyroid hormone in patients with primary hyperparathyroidism undergoing first and reoperative surgery

Bergenfelz, A LU ; Isaksson, A LU ; Lindblom, P LU ; Westerdahl, J LU and Tibblin, Sten (1998) In British Journal of Surgery 85(8). p.32-1129
Abstract

BACKGROUND: The distinction between solitary parathyroid adenoma and hyperplasia can sometimes be difficult during surgery for primary hyperparathyroidism (pHPT), especially in patients who have undergone previous thyroid or parathyroid surgery. The use of intraoperative parathyroid hormone (PTH) monitoring as a possible diagnostic tool was therefore investigated.

METHODS: Intraoperative levels of PTH were measured in 119 patients during 121 operations (including 14 reoperations) for pHPT. The mean(s.d.) preoperative serum calcium level was 2.79(0.21) mmol/l. Blood samples were drawn before, and at 5 and 15 min after, excision of the first enlarged parathyroid gland. PTH was analysed electively in 61 patients and on-line by a... (More)

BACKGROUND: The distinction between solitary parathyroid adenoma and hyperplasia can sometimes be difficult during surgery for primary hyperparathyroidism (pHPT), especially in patients who have undergone previous thyroid or parathyroid surgery. The use of intraoperative parathyroid hormone (PTH) monitoring as a possible diagnostic tool was therefore investigated.

METHODS: Intraoperative levels of PTH were measured in 119 patients during 121 operations (including 14 reoperations) for pHPT. The mean(s.d.) preoperative serum calcium level was 2.79(0.21) mmol/l. Blood samples were drawn before, and at 5 and 15 min after, excision of the first enlarged parathyroid gland. PTH was analysed electively in 61 patients and on-line by a modified assay for intact PTH in 48 patients. Both procedures were used in ten patients.

RESULTS: The mean(s.d.) decline in PTH concentration in 101 patients with primary exploration due to solitary adenoma was 63(17) per cent after 5 min (n=84) and 83(10) per cent after 15 min. The patients with primary exploration because of multiglandular disease (n=6) were correctly predicted not to have parathyroid adenoma.

CONCLUSION: Measurement of PTH levels during surgery for pHPT is a highly sensitive method for differentiating between single and multiple gland disease. The on-line monitoring of PTH is clinically useful in patients who have undergone previous neck surgery. Its role in pHPT surgery at primary exploration should be evaluated in prospective trials.

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publication status
published
subject
keywords
Adenoma, Adult, Aged, Aged, 80 and over, Biomarkers, Female, Follow-Up Studies, Humans, Hyperparathyroidism, Intraoperative Care, Male, Middle Aged, Parathyroid Hormone, Reoperation, Journal Article, Research Support, Non-U.S. Gov't
in
British Journal of Surgery
volume
85
issue
8
pages
4 pages
publisher
John Wiley & Sons
external identifiers
  • scopus:0031828306
ISSN
0007-1323
DOI
10.1046/j.1365-2168.1998.00824.x
language
English
LU publication?
no
id
0634ca8e-ec3c-49d5-a4bd-5c036612d1e1
date added to LUP
2017-05-10 17:38:10
date last changed
2017-05-14 04:51:08
@article{0634ca8e-ec3c-49d5-a4bd-5c036612d1e1,
  abstract     = {<p>BACKGROUND: The distinction between solitary parathyroid adenoma and hyperplasia can sometimes be difficult during surgery for primary hyperparathyroidism (pHPT), especially in patients who have undergone previous thyroid or parathyroid surgery. The use of intraoperative parathyroid hormone (PTH) monitoring as a possible diagnostic tool was therefore investigated.</p><p>METHODS: Intraoperative levels of PTH were measured in 119 patients during 121 operations (including 14 reoperations) for pHPT. The mean(s.d.) preoperative serum calcium level was 2.79(0.21) mmol/l. Blood samples were drawn before, and at 5 and 15 min after, excision of the first enlarged parathyroid gland. PTH was analysed electively in 61 patients and on-line by a modified assay for intact PTH in 48 patients. Both procedures were used in ten patients.</p><p>RESULTS: The mean(s.d.) decline in PTH concentration in 101 patients with primary exploration due to solitary adenoma was 63(17) per cent after 5 min (n=84) and 83(10) per cent after 15 min. The patients with primary exploration because of multiglandular disease (n=6) were correctly predicted not to have parathyroid adenoma.</p><p>CONCLUSION: Measurement of PTH levels during surgery for pHPT is a highly sensitive method for differentiating between single and multiple gland disease. The on-line monitoring of PTH is clinically useful in patients who have undergone previous neck surgery. Its role in pHPT surgery at primary exploration should be evaluated in prospective trials.</p>},
  author       = {Bergenfelz, A and Isaksson, A and Lindblom, P and Westerdahl, J and Tibblin, Sten},
  issn         = {0007-1323},
  keyword      = {Adenoma,Adult,Aged,Aged, 80 and over,Biomarkers,Female,Follow-Up Studies,Humans,Hyperparathyroidism,Intraoperative Care,Male,Middle Aged,Parathyroid Hormone,Reoperation,Journal Article,Research Support, Non-U.S. Gov't},
  language     = {eng},
  number       = {8},
  pages        = {32--1129},
  publisher    = {John Wiley & Sons},
  series       = {British Journal of Surgery},
  title        = {Measurement of parathyroid hormone in patients with primary hyperparathyroidism undergoing first and reoperative surgery},
  url          = {http://dx.doi.org/10.1046/j.1365-2168.1998.00824.x},
  volume       = {85},
  year         = {1998},
}