Intraoperative Parathyroid Hormone Monitoring in Parathyroidectomy for Tertiary Hyperparathyroidism

Ermer, Jae P.; Kelz, Rachel R.; Fraker, Douglas L.; Wachtel, Heather

doi:10.1016/j.jss.2019.06.020

Cited by 7 publications

(12 citation statements)

References 26 publications

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“…However, several studies have reported slightly delayed clearance of ioPTH in patients with THPT. 300,341,359 This is likely due to a decrease in GFR over time following kidney transplant that results in the increased production and accumulation of PTH. 342 Consequently, the literature surrounding the utility of ioPTH assays in patients with THPT is somewhat more robust than that for patients with secondary disease, but is not definitive.…”

Section: Tertiary Hpt: Criteria For Iopth Decline and Utility Of Iopt...mentioning

confidence: 99%

“…128,342,356,359,365,366 Not all patients may experience a decrease in 50% within 10 minutes, so expansion of the timeframe to 15 or 25 minutes may include more patients while maintaining > 89% sensitivity to predict cure. 341,356 An alternative approach is a PTH target, which is also often employed during PTX. A final ioPTH of <200 pg/mL is the most sensitive for predicting long-term normocalcemia; more stringent criteria of a final ioPTH of <60 pg/mL or a 50% decrease and into the normal range had lower sensitivities of 68% and 66%, respectively.…”

Section: Tertiary Hpt: Criteria For Iopth Decline and Utility Of Iopt...mentioning

confidence: 99%

“…Because of the lack of well-established PTH targets, low overall failure rates, and patients attaining cure without meeting ioPTH decrease criteria, some authors ultimately conclude the utilization of ioPTH during PTX for tertiary disease is not critical. 341,342 Conversely, other author groups concluded that ioPTH testing impacted the real-time operative care of THPT as ioPTH assays allow for limited rather than subtotal resections in 9% to 20% of patients. 356,359 Failure to decline may indicate the presence of ectopic or supernumerary glands.…”

Section: Tertiary Hpt: Criteria For Iopth Decline and Utility Of Iopt...mentioning

confidence: 99%

“…Application of the Miami criterion, drop of ioPTH by half from the baseline level, has been determined in several studies to be highly sensitive to predict cure for THPT, which was defined as normocalcemia post-PTX 128,342,356,359,365,366. Not all patients may experience a decrease in 50% within 10 minutes, so expansion of the timeframe to 15 or 25 minutes may include more patients while maintaining >89% sensitivity to predict cure 341,356. An alternative approach is a PTH target, which is also often employed during PTX.…”

Section: Planning Of Surgerymentioning

confidence: 99%

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The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism

Dream

Kuo

et al. 2022

Annals of Surgery

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Objective: To develop evidence-based recommendations for safe, effective, and appropriate treatment of secondary (SHPT) and tertiary (THPT) renal hyperparathyroidism. Background: Hyperparathyroidism is common among patients with chronic kidney disease, end-stage kidney disease, and kidney transplant. The surgical management of SHPT and THPT is nuanced and requires a multidisciplinary approach. There are currently no clinical practice guidelines that address the surgical treatment of SHPT and THPT. Methods: Medical literature was reviewed from January 1, 1985 to present January 1, 2021 by a panel of 10 experts in SHPT and THPT. Recommendations using the best available evidence was constructed. The American College of Physicians grading system was used to determine levels of evidence. Recommendations were discussed to consensus. The American Association of Endocrine Surgeons membership reviewed and commented on preliminary drafts of the content. Results: These clinical guidelines present the epidemiology and pathophysiology of SHPT and THPT and provide recommendations for work-up and management of SHPT and THPT for all involved clinicians. It outlines the preoperative, intraoperative, and postoperative management of SHPT and THPT, as well as related definitions, operative techniques, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Preoperative and Perioperative Care, Surgical Planning and Parathyroidectomy, Adjuncts and Approaches, Outcomes, and Reoperation. Conclusions: Evidence-based guidelines were created to assist clinicians in the optimal management of secondary and tertiary renal hyperparathyroidism.

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Section: Tertiary Hpt: Criteria For Iopth Decline and Utility Of Iopt...mentioning

confidence: 99%

Section: Tertiary Hpt: Criteria For Iopth Decline and Utility Of Iopt...mentioning

confidence: 99%

Section: Tertiary Hpt: Criteria For Iopth Decline and Utility Of Iopt...mentioning

confidence: 99%

Section: Planning Of Surgerymentioning

confidence: 99%

See 2 more Smart Citations

The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism

Dream

Kuo

et al. 2022

Annals of Surgery

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“…Postoperative follow-up found a low recurrence rate of HPT and normal parathyroid function ( 54 ). Since sPTX reduces the risk of hypoparathyroidism, it is generally preferred for THPT therapy ( 55 ).…”

Section: Treatment For Hptmentioning

confidence: 99%

Advances in the treatment of secondary and tertiary hyperparathyroidism

et al. 2022

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Secondary hyperparathyroidism (SHPT) and tertiary hyperparathyroidism (THPT) are common and complicated clinical endocrine diseases. The parathyroid glands maintain endocrine homeostasis by secreting parathyroid hormone to regulate blood calcium levels. However, structural alterations to multiple organs and systems occur throughout the body due to hyperactivity disorder in SHPT and THPT. This not only decreases the patients’ quality of life, but also affects mortality. Since current treatments for these diseases remains unclear, we aimed to develop a comprehensive review of advances in the treatment of SHPT and THPT according to the latest relevant researches.

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Surgical Management of Secondary and Tertiary Hyperparathyroidism

Bartz-Kurycki,

Dream

2024

Surgical Clinics of North America

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Intraoperative Parathyroid Hormone Monitoring in Parathyroidectomy for Tertiary Hyperparathyroidism

Cited by 7 publications

References 26 publications

The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism

The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism

Advances in the treatment of secondary and tertiary hyperparathyroidism

Surgical Management of Secondary and Tertiary Hyperparathyroidism

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