BACKGROUND: The objective of this pilot study was to evaluate the use of intraoperative iPTH measurement in combination with bilateral neck exploration in patients with primary hyperparathyroidism. METHODS: A prospective study was conducted in a single centre university hospital in Switzerland comprising 33 patients with primary hyperparathyroidism undergoing neck surgery. No routine preoperative localisation studies were conducted. Intraoperative iPTH measurement was performed at defined times. Exploration was discontinued when iPTH fell below 15% of baseline. RESULTS: For all patients with adenoma the median serum iPTH decreased to 11.9% (standard deviation 5.5%) of baseline concentrations. All patients with hyperplasia achieved normocalcaemia. At median follow-up of 17.7 weeks neither recurrent nor persistent hypercalcaemia was observed. Eleven patients were explored unilaterally. CONCLUSION: Measurement of intraoperative serum iPTH is a helpful tool in the differentiation of single adenoma from hyperplastic glands. When we call for a strict 78% decrease in serum iPTH from base levels after 10 minutes, measurement of this marker protein even allows differentiation of single- from multi-glandular disease.
BACKGROUND: The objective of this pilot study was to evaluate the use of intraoperative iPTH measurement in combination with bilateral neck exploration in patients with primary hyperparathyroidism. METHODS: A prospective study was conducted in a single centre university hospital in Switzerland comprising 33 patients with primary hyperparathyroidism undergoing neck surgery. No routine preoperative localisation studies were conducted. Intraoperative iPTH measurement was performed at defined times. Exploration was discontinued when iPTH fell below 15% of baseline. RESULTS: For all patients with adenoma the median serum iPTH decreased to 11.9% (standard deviation 5.5%) of baseline concentrations. All patients with hyperplasia achieved normocalcaemia. At median follow-up of 17.7 weeks neither recurrent nor persistent hypercalcaemia was observed. Eleven patients were explored unilaterally. CONCLUSION: Measurement of intraoperative serum iPTH is a helpful tool in the differentiation of single adenoma from hyperplastic glands. When we call for a strict 78% decrease in serum iPTH from base levels after 10 minutes, measurement of this marker protein even allows differentiation of single- from multi-glandular disease.