Intraoperative decay profile of intact (1-84) parathyroid hormone in surgery for renal hyperparathyroidism—a consecutive series of 80 patients

Lokey, Jonathan S.; Pattou, François; Mondragón-Sánchez, Alejandro; Minuto, Michele; Mullineris, Barbara; Wambergue, François; Foissac-Geroux, Philippe; Noël, Christian; Sagazan, Henri Le Monies de; VanHille, Pierre; Proye, C

doi:10.1067/msy.2000.110431

Cited by 74 publications

(67 citation statements)

References 13 publications

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“…A drop in PTH levels to "normal" values is delayed until 30 minutes after total parathyroidectomy; however, a rapid PTH assay 10 minutes after removal of the last parathyroid gland seems as accurate as an assay performed at 30 minutes thereafter. Intraoperative PTH monitoring demonstrates relevant decreases in rapid PTH levels after total parathyroid removal similar to those previously reported in patients with primary hyperparathyroidism [19]. Our results confi rm this fi nding and encourage the use of iPTH as an assessment of complete parathyroid removal in secondary renal hyperparathyroidism.…”

Section: Discussionsupporting

confidence: 88%

The pattern of the descent of PTH measured by intraoperative monitoring of intact-PTH in surgery for renal hyperparathyroidism

Echenique-Elizondo

Díaz-Aguirregoitia

Amondarain³

et al. 2008

Indian J Surg

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Background In the setting of total parathyroidectomy and autotransplantation surgery (TPTxAS) treatment for secondary hyperparathyroidism (SHPT) we evaluated whether intraoperative parathyroid hormone (iPTH) monitoring is an useful tool as a reference for total parathyroid removal.Design Prospective open single value measurement effi cacy study of one intraoperative (i.o.) diagnostic monitoring method (iPTH ) on a cohort of surgical patients. Main outcome measures Serum levels of iPTH during surgery and prediction time of the of descent of PTH levels (measured in the clinic, at admission day and intra-operatively during induction of anesthesia, and every 5 and 10 minutes after removal of adenoma and 24 hours thereafter) were analyzed. PatientsResults iPTH levels dropped clearly at ten minutes in all 35 patients and were non-measurable at 24 hours. iPTH decreased from pathological (1302.24 + 424.9 pg/ml) to half (50%) the values at the third intra-operative determination -minute 10 - (614.8 ± 196.62) and was undetectable at 24 hours.Conclusions Intra-operative measurement of iPTH is useful in the prediction of complete removal of all parathyroid tissue prior to autotransplantation thus avoiding persistence because of incomplete surgery.

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Section: Discussionsupporting

confidence: 88%

The pattern of the descent of PTH measured by intraoperative monitoring of intact-PTH in surgery for renal hyperparathyroidism

Echenique-Elizondo

Díaz-Aguirregoitia

Amondarain³

et al. 2008

Indian J Surg

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“…Several studies report that a significant reduction in IOPTH levels compared to preoperative levels is highly predictive of postoperative success. Additionally, IOPTH is regarded by some as a valuable tool in intraoperative decision-making and to discern patients with both supernumerary, ectopic and fewer than four parathyroid glands removed [25,[80][81][82][83] (EL 1b-3). In sharp contrast, other authors consider IOPTH of no or limited practical utility.…”

Section: Surgery With and Without Utilization Of Intraoperative Paratmentioning

confidence: 99%

Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons

Lorenz

Bartsch

Sancho

et al. 2015

Langenbecks Arch Surg

108

130

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Background Despite advances in the medical management of secondary hyperparathyroidism due to chronic renal failure and dialysis (renal hyperparathyroidism), parathyroid surgery remains an important treatment option in the spectrum of the disease. Patients with severe and complicated renal hyperparathyroidism (HPT), refractory or intolerant to medical therapy and patients with specific requirements in prospect of or excluded from renal transplantation may require parathyroidectomy for renal hyperparathyroidism. Methods Present standard and actual controversial issues regarding surgical treatment of patients with hyperparathyroidism due to chronic renal failure were identified, and pertinent literature was searched and reviewed. Whenever applicable, evaluation of the level of evidence concerning diagnosis and management of renal hyperparathyroidism according to standard criteria and recommendation grading were employed. Results were discussed at the 6th Workshop of the European Society of Endocrine Surgeons entitled Hyperparathyroidism due to multiple gland disease: An evidence-based perspective.Results Presently, literature reveals scant data, especially, no prospective randomized studies to provide sufficient levels of evidence to substantiate recommendations for surgery in renal hyperparathyroidism. Appropriate surgical management of renal hyperparathyroidism involves standard bilateral exploration with bilateral cervical thymectomy and a spectrum of four standardized types of parathyroid resection that reveal comparable outcome results with regard to levels of evidence and recommendation. Specific patient requirements may favour one over the other procedure according to individualized demands. Conclusions Surgery for patients with renal hyperparathyroidism in the era of calcimimetics continues to play an important role in selected patients and achieves efficient control of hyperparathyroidism. The overall success rate and longterm control of renal hyperparathyroidism and optimal handling of postoperative metabolic effects also depend on the timely indication, individually suitable type of parathyroid resection and specialized endocrine surgery.

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“…As in PHP, the intraoperative determination of intact PTH may be useful in surgery of patients with chronic renal failure and hyperparathyroidism, suggesting missed or hyperfunctioning supernumerary glands, when levels fail to decrease after parathyroid tissue removal (19). The aim of the present study was to observe retrospectively the decay profile of intact PTH in patients undergoing parathyroidectomy for PHP, refratory SHP or THP and to compare it to the cure observed in postoperative follow-up, in order to assess the utility of this procedure in predicting cure.…”

Section: Introductionmentioning

confidence: 99%

Usefulness of a rapid immunometric assay for intraoperative parathyroid hormone measurements

Ohe

Santos

Kunii

et al. 2003

Braz J Med Biol Res

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Intraoperative parathyroid hormone (IO-PTH) measurements have been proposed to improve operative success rates in primary, secondary and tertiary hyperparathyroidism (PHP, SHP and THP). Thirty-one patients requiring parathyroidectomy were evaluated retrospectively from June 2000 to January 2002. Sixteen had PHP, 7 SHP and 8 THP. Serum samples were taken at times 0 (before resection), 10, 20 and 30 min after resection of each abnormal parathyroid gland. Samples from 28 patients were frozen at -70ºC for subsequent tests, whereas samples from three patients were tested while surgery was being performed. IO-PTH was measured using the Elecsys immunochemiluminometric assay (Roche, Mannheim, Germany). The time necessary to perform the assay was 9 min. All samples had a second measurement taken by a conventional immunofluorimetric method. We considered as cured patients who presented normocalcemia in PHP and THP, and normal levels of PTH in SHP one month after surgery and who remained in this condition throughout the follow-up of 1 to 20 months. When rapid PTH assay was compared with a routine immunofluorimetric assay, excellent correlation was observed (r = 0.959, P < 0.0001). IO-PTH measurement showed a rapid average decline of 78.8% in PTH 10 min after adenoma resection in PHP and all patients were cured. SHP patients had an average IO-PTH decrease of 89% 30 min after total parathyroidectomy and cure was observed in 85.7%. THP showed an average IO-PTH decrease of 91.9%, and cure was obtained in 87.5% of patients. IO-PTH can be a useful tool that might improve the rate of successful treatment of PHP, SHP and THP.

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Intraoperative decay profile of intact (1-84) parathyroid hormone in surgery for renal hyperparathyroidism—a consecutive series of 80 patients

Cited by 74 publications

References 13 publications

The pattern of the descent of PTH measured by intraoperative monitoring of intact-PTH in surgery for renal hyperparathyroidism

The pattern of the descent of PTH measured by intraoperative monitoring of intact-PTH in surgery for renal hyperparathyroidism

Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons

Usefulness of a rapid immunometric assay for intraoperative parathyroid hormone measurements

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