S C Garner1, G S Leight. 1. Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Abstract
BACKGROUND: Successful surgical management of primary hyperparathyroidism (1 degree HPT) historically has required bilateral neck exploration. The intraoperative parathyroid hormone (IO-PTH) assay allows a more limited procedure by confirming complete removal of hypersecreting tissue. METHODS: Plasma samples were obtained from 130 consecutive patients both before (preincision and preexcision baselines) and at approximately 5 and 10 minutes (and additional times) after removal of abnormal parathyroid tissue. Samples were assayed for IO-PTH by a rapid, two-site immunochemiluminescent assay (ICMA) with a 7-minute incubation at 45 degrees C. RESULTS: Plasma IO-PTH decreased by at least 50% in 126 of 130 cases; however, three of these cases were false positives. The four cases in which IO-PTH fell < 50% were classified as two true negatives and two false negatives. A single adenoma was removed in 125 cases, and two or three hyperplastic glands were removed in five cases. CONCLUSIONS: IO-PTH predicted the postoperative outcome in 125 of 130 cases (96.2%), including two of five cases in which multiple hyperplastic glands were removed, and 1 degree HPT was successfully treated in 97.7% (127/130) of the cases. The IO-PTH procedure can provide valuable confirmation to the endocrine surgeon; however, other sources of information must also be used to ensure that all hyperplastic glands are identified.
BACKGROUND: Successful surgical management of primary hyperparathyroidism (1 degree HPT) historically has required bilateral neck exploration. The intraoperative parathyroid hormone (IO-PTH) assay allows a more limited procedure by confirming complete removal of hypersecreting tissue. METHODS: Plasma samples were obtained from 130 consecutive patients both before (preincision and preexcision baselines) and at approximately 5 and 10 minutes (and additional times) after removal of abnormal parathyroid tissue. Samples were assayed for IO-PTH by a rapid, two-site immunochemiluminescent assay (ICMA) with a 7-minute incubation at 45 degrees C. RESULTS: Plasma IO-PTH decreased by at least 50% in 126 of 130 cases; however, three of these cases were false positives. The four cases in which IO-PTH fell < 50% were classified as two true negatives and two false negatives. A single adenoma was removed in 125 cases, and two or three hyperplastic glands were removed in five cases. CONCLUSIONS: IO-PTH predicted the postoperative outcome in 125 of 130 cases (96.2%), including two of five cases in which multiple hyperplastic glands were removed, and 1 degree HPT was successfully treated in 97.7% (127/130) of the cases. The IO-PTH procedure can provide valuable confirmation to the endocrine surgeon; however, other sources of information must also be used to ensure that all hyperplastic glands are identified.
Authors: M-H Gannagé-Yared; B Abboud; M Amm-Azar; A Saab; S Khalife; G Halaby; C Atallah; R Medlej; S Jambart Journal: J Endocrinol Invest Date: 2009-02 Impact factor: 4.256
Authors: Patrick B O'Neal; Vitaliy Poylin; Peter Mowschenson; Sareh Parangi; Gary Horowitz; Pravin Pant; Per-Olof Hasselgren Journal: World J Surg Date: 2009-08 Impact factor: 3.352