Intraoperative Parathyroid Hormone Assay in Patients With Primary Hyperparathyroidism and Double Adenoma

Abstract

Intraoperative PTH monitoring and maintenance of normocalcemia after surgery confirm previous reports that DAs do exist and are not simply missed cases of 4-gland hyperplasia. Intraoperative PTH monitoring accurately predicted the success of parathyroidectomy in 98% of patients with DAs.

Use of a Technetium99m-Sestamibi Scan to Detect Ipsilateral Double Adenoma in a Patient with Primary Hyperparathyroidism: A Case Report

“…1 For 87% to 91% of patients with PHPT, a single adenoma is the culprit. 2 The remaining cases are caused by 4-gland hyperplasia (10% to 15%) and the controversial DA.…”

“…2 However, studies confirm the presence of DAs in 2% to 15% of patients undergoing parathyroid explorations; often, one is located on each side of the neck.…”

“…3 A decrease of at least 50% in perioperative iPTH suggests likely biochemical cure. 2 In a 2010 clinical study, 3 use of IOPTH level helped physicians identify a DA that was missed by presurgical scans; IOPTH level was associated with 100% sensitivity in detection compared with ultrasound or nuclear imaging alone (15% of DAs are missed). 3 Case reports appear to confirm that IOPTH level can serve as an accurate predictor of cure in combination with presurgical scanning to help physicians prevent unsuccessful outcomes, surgical reexploration, and unnecessary patient costs.…”

“…3 Case reports appear to confirm that IOPTH level can serve as an accurate predictor of cure in combination with presurgical scanning to help physicians prevent unsuccessful outcomes, surgical reexploration, and unnecessary patient costs. 2,3 Despite these advantages, the use of IOPTH level is not yet widely accepted in the management of PHPT. 3 Concerns include increases in minimally invasive parathyroidectomy surgery time, cost, and reports of false-negative rates in other studies.…”

“…1 Most cases can be explained by a single parathyroid adenoma, defined as a solitary neoplastic lesion bordered by normal parathyroid tissue, which is followed by 4-gland hyperplasia and, rarely, parathyroid carcinoma. 2 Small subsets (2%-15%) of PHPT contain 2 solitary adenomas as seen during explorative parathyroidectomy, however. The double adenoma (DA) remains controversial among investigators, some of whom deny its existence.…”