Intraoperative and postoperative PTH secretion mode in patients with hyperparathyroidism

Fischer, Stefanie; Flentje, D.; Kettelhack, Christoph; Schmidt-Gayk, J; Buhr, H. J.; Herfarth, Christian

doi:10.1007/bf01658524

Cited by 24 publications

(9 citation statements)

References 12 publications

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“…The intraoperative PTH assay has clearly shown a different pattern of decay in patients with an adenoma compared to those with hyperplasia [24,28,29]. Flentje et al reported that after removal of an adenoma the PTH level reached the normal range within 15 minutes, whereas following excision of the first parathyroid gland none of the patients with multiglandular disease had a PTH level within the normal range at the end of the same period of observation [29].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Parathormone Measurement in Patients with Multiple Endocrine Neoplasia Type I Syndrome and Hyperparathyroidism

et al. 2000

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Total or subtotal parathyroidectomy is considered the treatment of choice for multiple endocrine neoplasia type I (MEN-I)-associated primary hyperparathyroidism (HPT). However, persistent or recurrent HPT is frequently observed. The development of a rapid two-site immunoradiometric assay (IRMA) method for measuring intact parathormone (PTH) has provided a valuable tool for recognizing possible surgical failures. Our experience includes 16 MEN-I patients (10 females, 6 males) of mean age 35.5 years operated on between 1990 and 1996. Total parathyroidectomy (TPTX) with autotransplantation of parathyroid tissue was the standard treatment. Blood samples for PTH measurement were drawn at the induction of anesthesia (basal value), 10 and 20 minutes after the removal of each gland, and 60 minutes after TPTX. Rapid PTH measurement, which required only 15 minutes of incubation at 37 degrees C, showed a highly significant correlation (p < 0.0001) with the standard method. Circulating PTH levels exhibited a stepwise decrease during TPTX, reaching a mean value of 22.3% of the baseline 20 minutes after removal of the last gland. Two patients showed a prompt decrease of PTH after removal of the single enlarged gland, featuring the kinetics observed in the adenomas. One of these two patients was successfully treated with more conservative surgery. None of the patients showed persistence or recurrence of HPT. In our experience, intraoperative measurement of PTH seems to be a valuable adjunct in both the diagnosis of multiglandular involvement and the prediction of surgical treatment in patients with primary parathyroid hyperplasia.

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Section: Discussionmentioning

confidence: 99%

Intraoperative Parathormone Measurement in Patients with Multiple Endocrine Neoplasia Type I Syndrome and Hyperparathyroidism

et al. 2000

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“…We considered the question of limited surgical access under local anaesthesia. In favor of this procedure were the following arguments: first, approximately 85% of patients with PHP have a single enlarged parathyroid gland [10]; second, an experienced radiologist using ultrasonography can find the adenonaa in 80% of patients [I 1]; third, intra-operative measurements of urinary cyclic AMP (UcAMP) [12][13][14][15] and intact parathyroid hormone (PTH) [16][17][18][19][20] are efficient methods to monitor the success of the operation. The aim of this study was to evaluate the results of minimal surgical therapy under local anesthesia.…”

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confidence: 99%

Parathyroid adenomectomy under local anesthesia with intra‐operative monitoring of UcAMP and/or 1‐84 PTH

Chapuis

Fulla

et al. 1992

World j. surg.

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Because 80% of patients with primary hyperparathyroidism have a single adenoma and because most adenomas are now visualized by ultrasonography, we have attempted to remove these suspected single adenomas under local anesthesia with intra-operative monitoring of urinary cAMP (UcAMP) and 1-84 parathyroid hormone (PTH) serum levels. In the last 2 years, 45 patients (mean age 65 years) with primary hyperparathyroidism underwent surgery with local anesthesia when a single adenoma was strongly suspected by ultrasonography. Patients with equivocal or misleading ultrasonography, e.g., those with associated thyroid or multiglandular pathology and those who were non-cooperative, were excluded from this procedure. UcAMP and 1-84 PTH were determined prior to the incision, at the time of removal of the adenoma, and at regular intervals until 120 minutes after the operation. Results were available 45 min to 60 min after sampling for PTH and 60 min to 80 min for UcAMP. Forty-two adenomas were removed through a 2 cm to 3 cm skin incision in a mean time of 25 minutes, with no adverse effect, no morbidity, and minimal discomfort. The 42 patients were normocalcaemic on follow-up. The monitorings always predicted the success of the operation. In the 3 remaining patients, because the monitorings remained elevated at the end of the procedure, the patients underwent classical bilateral neck dissection under general anesthesia. This new approach can be safely accomplished with short operative time and hospital stay. The absence of general anesthesia is reassuring for the patients who are reluctant to undergo general anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)

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“…S uccessful surgical treatment of primary hyperparathyroidism is associated with a return to normal in postoperative serum intact parathyroid hormone (PTH) and serum calcium levels. It is known that the PTH concentration falls after removal of an adenoma 1–3 . Afterward, one sees a gradual recovery of the secretion by the remaining parathyroid glands, which are no longer suppressed by the adenoma 4 .…”

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confidence: 99%

“…It is known that the PTH concentration falls after removal of an adenoma. [1][2][3] Afterward, one sees a gradual recovery of the secretion by the remaining parathyroid glands, which are no longer suppressed by the adenoma. 4 In the same period, a decrease of the serum calcium is expected.…”

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confidence: 99%

Transient Rise in Intact Parathyroid Hormone Concentration after Surgery for Parathyroid Adenoma

Ferrer-Ramirez¹,

Domingo²,

Solá³

et al. 2003

Otolaryngol.--head neck surg.

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OBJECTIVE: Our goal was to describe the course of parathyroid hormone (PTH) after surgery for primary hyperparathyroidism (PHPT). PTH levels drop to low values after parathyroidectomy for PHPT. However, in some patients, a rebound transient increase in PTH concentrations can occur. STUDY DESIGN AND SETTING: A prospective study included 72 patients who underwent surgical exploration for PHPT. A single adenoma was found in 57 patients (79.1%), 2 adenomas were found in 2 (2.7%), and parathyroid hyperplasia was found in 13 (18.05%). The postoperative PTH secretion was studied in those patients who had an adenoma excised. RESULTS: This phenomenon was noted in 18 (31.6%) patients between 4 and 12 weeks, although total calcium concentrations were normal (9.3 ± 0.6 mg/ dL). Before surgery these patients had a more remarkable hyperparathyroidism (clinical and biochemical) than the others, but differences were not significant. CONCLUSION: Postoperative increases in PTH concentration can occur after successful parathyroidectomy. These increases are transient and do not indicate persistent or recurrent disease.

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Intraoperative and postoperative PTH secretion mode in patients with hyperparathyroidism

Cited by 24 publications

References 12 publications

Intraoperative Parathormone Measurement in Patients with Multiple Endocrine Neoplasia Type I Syndrome and Hyperparathyroidism

Intraoperative Parathormone Measurement in Patients with Multiple Endocrine Neoplasia Type I Syndrome and Hyperparathyroidism

Parathyroid adenomectomy under local anesthesia with intra‐operative monitoring of UcAMP and/or 1‐84 PTH

Transient Rise in Intact Parathyroid Hormone Concentration after Surgery for Parathyroid Adenoma

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