Influence of common clinical variables on intraoperative parathyroid hormone monitoring during surgery for primary hyperparathyroidism

Faheem, Michael; Sakr, Mahmoud; Nabawi, Ayman; Abdel-Aziz, Tarek Ezzat; Jong, Mechteld C. de; García, Virginia Rozalén; Lam, Francis; Soromani, Christine; Smart, J; Honour, JW; Kurzawinski, Tom

doi:10.1007/s40618-020-01201-z

Cited by 5 publications

(3 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For instance, Leiker et al 15 demonstrated that age alone was not predictor of IOPTH kinetics, but did interact with body mass index in determining its effect on PTH half-life. Shawky et al 22 presented a large retrospective study, evaluating common clinical variables and their effects on IOPTH kinetics, in which age was associated with greater IOPTH at all points, but it did not affect long-term cure when using the Miami criterion. Indeed, the Miami criterion has been shown to mitigate the age-related challenges of preoperative diagnosis uncertainty with comparable cure rates between the extremes of age groups.…”

Section: Discussionmentioning

confidence: 99%

The effect of chronic kidney disease on intraoperative parathyroid hormone: A linear mixed model analysis

Graves

Hwang

McManus

et al. 2021

Surgery

View full text Add to dashboard Cite

Background: Reduced creatinine clearance is an indication for surgery in asymptomatic primary hyperparathyroidism, and a significant proportion of patients undergoing parathyroidectomy have chronic kidney disease. The purpose of this study was to evaluate the kinetics of intraoperative parathyroid hormone decline during parathyroidectomy in patients who have chronic kidney disease compared with those with who have normal renal function. Methods: This is a single-center, retrospective study of patients with primary hyperparathyroidism undergoing parathyroidectomy (n ¼ 646). Patients were grouped based on estimated glomerular filtration rate greater than (normal renal function) or less than (chronic kidney disease) 60 mL/min/ 1.73m 2 . All patients had intraoperative parathyroid hormone monitoring and 6-month postoperative serum studies to confirm surgical cure. Intraoperative parathyroid hormone kinetic curves were analyzed using a linear mixed model. Results: Despite similar pre-excision values, patients with chronic kidney disease had significantly higher intraoperative parathyroid hormone values at 5 minutes (76 vs 58 pg/mL, P ¼ .02) and 10 minutes (54 vs 37 pg/mL, P ¼ .004) postexcision. No significant difference was observed in whether patients met Miami criterion by 5 minutes (chronic kidney disease 71%, normal renal function 78%, P ¼ .255) or by 10 minutes (chronic kidney disease 95%, normal renal function 96%, P ¼ .751) postexcision. Using a linear mixed model, glomerular filtration rate did not have a significant effect on the change in intraoperative parathyroid hormone over time. Conclusion:Patients with chronic kidney disease had significantly higher postexcision intraoperative parathyroid hormone levels. However, renal function did not affect the change in intraoperative parathyroid hormone over time, nor did renal function ultimately affect the likelihood of meeting the Miami criterion. Intraoperative parathyroid hormone monitoring remains useful in this population, although additional time points may be needed to observe normalization of values.

show abstract

Section: Discussionmentioning

confidence: 99%

The effect of chronic kidney disease on intraoperative parathyroid hormone: A linear mixed model analysis

Graves

Hwang

McManus

et al. 2021

Surgery

View full text Add to dashboard Cite

show abstract

“…In our cohort, we had only one patient with a multi-gland disease, and in the five cases where parathyroid hyperplasia was found, we did not observe any difference in the PTH dynamics perioperatively. Clinical variables such as patient age, gland weight, serum calcium, vitamin D status, and renal function are reported to influence the IOPTH drop [ 2 ]. In our patient collective, we did not find any significant differences in age and renal function in the CG and non-CG.…”

Section: Discussionmentioning

confidence: 99%

“…Primary hyperparathyroidism is the third most frequently diagnosed endocrinological disorder [ 1 , 2 ]. The annual incidence of pHPT is about 20–25 per 100,000, making it the most common cause of hypercalcemia [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

The Effect of the Frequently Used Cinacalcet for pHPT during the COVID-19 Pandemic on Perioperative Decrease in Parathyroid Hormone

Radulova-Mauersberger

Keßler

Keßler³

et al. 2022

JCM

View full text Add to dashboard Cite

Background: Cinacalcet is a calcimimetic drug that has increasingly been used as a bridging therapy for primary hyperparathyroidism (pHPT), especially during the COVID-19 pandemic. The aim of our study was to investigate if preoperative cinacalcet therapy affects intraoperative parathyroid hormone (IOPTH) monitoring during parathyroidectomy, which is an important indicator for the success of surgery. Methods: In this single-center retrospective analysis, we studied the outcomes of 72 patients who underwent surgery for pHPT. We evaluated two groups: those with cinacalcet therapy before operation—the cinacalcet group (CG)—and those without medical therapy preoperatively (non-CG). In order to perform a between-group comparison of time trends, we fit a linear mixed-effects model with PTH as the response variable and predictors PTH levels preoperatively, group (cinacalcet yes/no), time, the group-by-time interaction, and a random intercept (per subject). Results: Our cohort included 51 (71%) women and 21 (29%) men, who were operated upon for pHPT in the period from January 2018 until August 2021. All patients were diagnosed with pHPT and 54% of the cohort were symptomatic for hypercalcemia. Moreover, 30% of the patients were treated with cinacalcet as a bridging therapy preoperatively, and this increased during the COVID-19 pandemic, as 64% of this group were treated in the last two years. Calcium values were significantly different before (p < 0.001) and after (p = 0.0089) surgery, but calcium level change did not differ significantly between the CG and non-CG. Parathyroid hormone (PTH) levels dropped significantly in both groups during 10 min IOPTH monitoring (p < 0.001), but there was no significant difference between the two groups (p = 0.212). Conclusions: In the examined patient cohort, the use of cinacalcet did not affect the value of IOPTH monitoring during surgery for pHPT.

show abstract

Surgical challenges of giant parathyroid adenomas weighing 10 g or more

Prabhakaran

Bhatt

Serpell

et al. 2022

J Endocrinol Invest

View full text Add to dashboard Cite

Influence of common clinical variables on intraoperative parathyroid hormone monitoring during surgery for primary hyperparathyroidism

Cited by 5 publications

References 26 publications

The effect of chronic kidney disease on intraoperative parathyroid hormone: A linear mixed model analysis

The effect of chronic kidney disease on intraoperative parathyroid hormone: A linear mixed model analysis

The Effect of the Frequently Used Cinacalcet for pHPT during the COVID-19 Pandemic on Perioperative Decrease in Parathyroid Hormone

Surgical challenges of giant parathyroid adenomas weighing 10 g or more

Contact Info

Product

Resources

About