Christian Bieglmayer1, Klaus Kaczirek, Gerhard Prager, Bruno Niederle. 1. Clinical Institute for Medical and Chemical Laboratory Diagnostics, Section of Surgical Endocrinology, Division of General Surgery, General Hospital of the Medical University and City of Vienna, Vienna, Austria. christian.bieglmayer@meduniwien.ac.at
Abstract
BACKGROUND: Commonly used assays for intact parathyroid hormone (iPTH) detect not only the biologically active 84-amino acid hormone [PTH1-84], but cross-react 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 PTH1-84 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 PTH1-84 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 PTH1-84 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 effectiveness in detecting missed glands, but the assay for PTH1-84 gave more reliable results than the iPTH assays, which overestimated the concentration of PTH and hampered the intrasurgical diagnosis of resection sufficiency.
BACKGROUND: Commonly used assays for intact parathyroid hormone (iPTH) detect not only the biologically active 84-amino acid hormone [PTH1-84], but cross-react 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 PTH1-84 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 PTH1-84 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 PTH1-84 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 effectiveness in detecting missed glands, but the assay for PTH1-84 gave more reliable results than the iPTH assays, which overestimated the concentration of PTH and hampered the intrasurgical diagnosis of resection sufficiency.
Authors: Catherine Madorin; Randall P Owen; William D Fraser; Phillip K Pellitteri; Brian Radbill; Alessandra Rinaldo; Raja R Seethala; Ashok R Shaha; Carl E Silver; Matthew Y Suh; Barrie Weinstein; Alfio Ferlito Journal: Eur Arch Otorhinolaryngol Date: 2011-11-20 Impact factor: 2.503
Authors: Clare Gardham; Paul E Stevens; Michael P Delaney; Marica LeRoux; Adrian Coleman; Edmund J Lamb Journal: Clin J Am Soc Nephrol Date: 2010-05-24 Impact factor: 8.237
Authors: Andrew J Leiker; Tina W F Yen; Dan C Eastwood; Kara M Doffek; Aniko Szabo; Douglas B Evans; Tracy S Wang Journal: JAMA Surg Date: 2013-07 Impact factor: 14.766
Authors: Philipp Riss; Reza Asari; Christian Scheuba; Christian Bieglmayer; Bruno Niederle Journal: Langenbecks Arch Surg Date: 2009-04-25 Impact factor: 3.445
Authors: Gürhan Sakman; Cem Kaan Parsak; Mustafa Balal; Gülşah Seydaoglu; Ismail Cem Eray; Gökhan Sarıtaş; Orhan Demircan Journal: Balkan Med J Date: 2014-03-01 Impact factor: 2.021