Impact of Race on Intraoperative Parathyroid Hormone Kinetics

Abstract

Hypothesis: African American patients exhibit different intraoperative parathyroid hormone (IOPTH) profiles than non-African American patients. Design: Retrospective review. Setting: University medical center. Patients: Nine hundred ten patients who underwent parathyroidectomy for primary hyperparathyroidism between July 2005 and August 2010. Interventions: All patients underwent preoperative imaging with ultrasonography and sestamibi; operative exploration; and IOPTH measurement at 2 points preexcision and 5 and 10 minutes postexcision. Main Outcome Measures: Preexcision and postexcision IOPTH measurements. Results: Of the 910 patients, 734 self-reported their race as white (81%); 91, Latino/other (10%); 56, Asian (6%); and 28, African American (3%). African American patients had significantly higher initial preexcision IOPTH levels compared with white patients (348 vs 202 pg/mL; P = .048) and significantly higher 5-minute postexcision IOPTH levels (151 vs 80 pg/mL; P = .01). The 10-minute postexcision IOPTH levels were similar between the 2 groups (52 vs 50 pg/mL). A similar percentage of white and African American patients had a 50% drop in IOPTH level at 10 minutes postexcision. No differences in IOPTH kinetics were observed in the other racial groups examined. Conclusions: African American patients with primary hyperparathyroidism exhibit significantly higher preincision and 5-minute postexcision IOPTH values when compared with white patients. The 10-minute postexcision IOPTH values did not differ between races. The altered IOPTH kinetics identified in African American patients may reflect the severity of biochemical disease but may also be related to genetically predetermined differences in parathyroid hormone metabolism.

The Final Intraoperative Parathyroid Hormone Level: How Low Should It Go?

“…Since that time, physicians who treat parathyroid disease have developed a significant clinical interest in parathyroid hormone kinetics. Research has been directed at understanding any clinical factors that may alter its effectiveness as a surgical adjunct, including the effects of age, race, body mass index, renal function, timing of measurement, and choice of anesthetic [2][3][4][5][6]. Clinical understanding of primary hyperparathyroidism (PHPT) has also seen a dramatic change in diagnosis and treatment over the past several decades [7].…”

Comparison of Initial Clinical Presentations between Primary Hyperparathyroidism Patients from New Brunswick and Changsha

“…Around 92% of PHPT patients who had surgery in Changsha were found to have parathyroid adenoma, which is twice as many as those in New Brunswick ( p < 0.01). Most of the PHPT patients in the US are postmenopausal women, and US PHPT patients are also heavier with higher fasting glucose levels, which may also reflect different genetic backgrounds between the two groups of patients as well as different genetically determined PTH metabolism [ 15 ]. The higher percentage of parathyroid hyperplasia might be due to selection bias.…”

Comparison between Second- and Third-Generation PTH Assays during Minimally Invasive Parathyroidectomy (MIP)

“…e IOPTH value drawn at 10 minutes following parathyroidectomy is the most accurate predictor of a successful MIP [6,7]. Age, impaired renal function [8], race (African American vs. others) [9], and high BMI [10] were shown to be negative predictors of IOPTH decline following MIP, while low 25 hydroxyvitamin D (25(OH)D) levels have been shown to either increase IOPTH drop [11] or have no effect [12,13].…”