Predictors of intra-operative parathyroid hormone decline in subjects operated for primary hyperparathyroidism by minimally invasive parathyroidectomy

Gannagé‐Yared, Marie‐Hélène; Abboud, Bassam; Amm-Azar, Mireille; Saab, Azza Abdel Rahman; Khalife, S.; Halaby, Georges; C, Atallah; Medlej, R; Jambart, S

doi:10.1007/bf03345707

Cited by 16 publications

(17 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Conversely, patients with higher FioPTHs were notably older, and with higher serum creatinine levels. Previous studies discussed the controversial aspects of age, and glomerular filtration rate (GFR), and their respective influences on ioPTH decline in patients with PHPT 20,21 . Although FioPTH decline to <40 pg/mL may be multi-factorial, younger age and more efficient renal function may play a role.…”

Section: Discussionmentioning

confidence: 99%

Justified Follow-Up: A Final Intraoperative Parathyroid Hormone (ioPTH) Over 40 pg/mL is Associated with an Increased Risk of Persistence and Recurrence in Primary Hyperparathyroidism

et al. 2014

View full text Add to dashboard Cite

Introduction After parathyroidectomy for sporadic primary hyperparathyroidism (PHPT), overall rates of persistence/recurrence are extremely low. A marker of increased risk for persistence/recurrence is needed. We hypothesized that final intraoperative parathyroid hormone (FioPTH) ≥40 pg/mL is indicative of increased risk for disease persistence/recurrence, and can be used to selectively determine degree of follow up. Method A retrospective review of PHPT patients undergoing parathyroidectomy with ioPTH monitoring was performed. An ioPTH decline of 50% was the only criteria for operation termination. Patients were grouped based on FioPTH of <40pg/mL, 40 to 59, and >60. Results Between 2001 and 2012, 1371 patients were included. Mean age was 61±0.4 years.78% were female. Overall persistence rate was 1.4%, with 2.9% recurrence rate. 976 (71%) had FioPTH<40, 228 (16.6%) had FioPTH 40-59, and 167 (12.2%) had FioPTH≥60. Mean follow-up was 21±0.6 months. FioPTH<40 were younger, with lower preoperative serum calcium, PTH and creatinine (all p≤0.001). FioPTH<40 had the lowest persistence rate (0.2%) versus FioPTH 40-59 (3.5%) or FioPTH≥60 (5.4%, p<0.001). Recurrence rate was also lowest in FioPTH<40 (1.3% vs. 5.9% vs. 8.2% respectively, p<0.001). Disease free status was greatest in FioPTH<40 at 2 years (98.5% vs. 96.8% vs. 90.5%) and 5 years (95.7% vs. 72.3% vs. 74.8%, p<0.01). Conclusion Patients with FioPTH<40 pg/mL had lower rates of persistence and recurrence, than FioPTH 40-59, or ≥60. Differences became more apparent after 2 years of follow-up. Patients with FioPTH ≥40 pg/mL warrant close and prolonged follow-up.

show abstract

Section: Discussionmentioning

confidence: 99%

Justified Follow-Up: A Final Intraoperative Parathyroid Hormone (ioPTH) Over 40 pg/mL is Associated with an Increased Risk of Persistence and Recurrence in Primary Hyperparathyroidism

et al. 2014

View full text Add to dashboard Cite

show abstract

“…Previous groups have reported a 9-12% rate of ioPTH failing to decline by 10 minutes in patients who ultimately were cured. (7,11) There was no clinically significant difference in meeting ioPTH criteria for cure between the patients with CRI vs NRF. Further subgroup analysis of the 99 patients with creatinine clearance < 40 ml/min was not significantly different, and by 10 minutes, 88% of patients with the most severe decline in renal function still met cure criteria.…”

Section: Discussionmentioning

confidence: 86%

“…(5) While it makes clinical sense that patient factors unrelated to PHPT, such as renal function or body habitus, may play a role in the kinetics of hormone clearance, few studies have examined the effect of patient preoperative characteristics on the accuracy of ioPTH monitoring to determine cure. (6,7)…”

Section: Introductionmentioning

confidence: 99%

“…(8) Not surprisingly then, mixed findings are reported on the predictive effect of renal function on ioPTH kinetics. (6,7) If patients with normal renal function (NRF) clear PTH more rapidly than patients with chronic renal insufficiency (CRI), there is a potential to reduce operative time and cost by requiring fewer ioPTH measurements. Furthermore, if surgeons believe that ioPTH is less accurate in patients with CRI, they may be inclined to put less trust in the ioPTH measurements, leading to longer operative times and potentially unnecessary dissections.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Is intraoperative parathyroid hormone testing in patients with renal insufficiency undergoing parathyroidectomy for primary hyperparathyroidism accurate?

Sohn

Oltmann

Schneider

et al. 2015

The American Journal of Surgery

View full text Add to dashboard Cite

Background Our aim was to determine whether chronic renal insufficiency (CRI) impacts intraoperative parathyroid hormone (ioPTH) monitoring during parathyroidectomy. We hypothesized that ioPTH monitoring in patients with chronic CRI would show slower decline, but still accurately predict cure. Methods A retrospective review of patients with primary hyperparathyroidism who underwent curative single adenoma parathyroidectomy. The percentage of patients reaching 50% decline of ioPTH was compared between groups stratified by renal function. Results Between 2000 and 2013, 950 patients met inclusion criteria. At five minutes, 66% of patients with CRI met curative criteria vs. 77% of normal renal function patients (p=0.001). At ten minutes, 89% vs. 92% met criteria (p=0.073), and by fifteen minutes, the gap narrowed to 95% vs. 97% (p=0.142). Conclusions Despite CRI patients with primary hyperparathyroidism having slower ioPTH decline after curative parathyroidectomy, 95% met ioPTH criteria by 15 minutes. Standard ioPTH criteria can be used with CRI patients.

show abstract

“…Several factors may influence IOPTH levels, among them patient age, size of the adenoma and GFR (22). In patients with parathyroid hyperplasia, in whom preoperative PTH levels are below 100 pg/ml, the 50% drop in IOPTH does not always mean that the surgery is radical (23, 24).…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Parathormone Assay and Radioguided Parathyroidectomy in Patients with Primary Hiperparathyroidism

Pypkowski

Dąbrowiecki

Wierzchowski

et al. 2010

Polish Journal of Surgery

View full text Add to dashboard Cite

The outcome of surgical treatment of primary hyperparathyreoidism (PHP) is largely dependent on the radicality of the operation. This is sometimes difficult due to abnormal location of the glands. The use of intraoperative parathormone assay (IOPTH) and a handheld gamma-ray detector (HGRD) might influence the outcome of treatment. The aim of the study was to assess the feasibility of intraoperative parathormone assay and handheld gamma ray detector in surgical treatment of primary hyperparathyroidism. material and methods. Prospective analysis of the treatment outcomes of patients with PHP undergoing surgery at the Dept. of General and Endocrine Surgery was accomplished. The patients were divided into two groups: G1 -patients in whom HGRD was used to intraoperatively locate the parathyroid glands; G2 -patients in whom both the HGRD and IOPTH were utilized. In all of the patients preoperative serum calcium and PTH measurements were taken. Thirty minutes before the scheduled start of the operation, patients from both groups received an 800 MBq dose of the Tc-MIBI radiomarker. Gamma radiation measurements were performed with the use of a Gamma Finder handheld device. In patients from the G2 group, serum PTH was assessed 10 minutes after the removal of the last gland. In the G1 group, bilateral neck exploration was performed. In the G2 group, the operation was brought to a close after the Miami criterion was met; in most cases, the surgery was limited to unilateral neck exploration. Results. Between 2007 and 2009 25 patients underwent surgery for PHP (group G1 -12, group G2 -13). There was one case of persistent hyperparathyroidism in group G1. All of the parathyroidectomies in group G2 were successful. No difference in the length of hospital stay were noted between the groups. The duration of surgery was longer in group G2. conclusions. Surgical treatment of PHP with the combined use of a handheld gamma radiation detector and an intraoperative parathormone assay yields satisfactory results despite limited tissue preparation.

show abstract

Predictors of intra-operative parathyroid hormone decline in subjects operated for primary hyperparathyroidism by minimally invasive parathyroidectomy

Abstract: Our results suggest that during MIP the presence of a parathyroid adenoma with a high weight, in an elderly subject or in a subject with altered renal function, will result in a lesser degree of IOPTH fall.

Cited by 16 publications

References 38 publications

Justified Follow-Up: A Final Intraoperative Parathyroid Hormone (ioPTH) Over 40 pg/mL is Associated with an Increased Risk of Persistence and Recurrence in Primary Hyperparathyroidism

Justified Follow-Up: A Final Intraoperative Parathyroid Hormone (ioPTH) Over 40 pg/mL is Associated with an Increased Risk of Persistence and Recurrence in Primary Hyperparathyroidism

Is intraoperative parathyroid hormone testing in patients with renal insufficiency undergoing parathyroidectomy for primary hyperparathyroidism accurate?

Intraoperative Parathormone Assay and Radioguided Parathyroidectomy in Patients with Primary Hiperparathyroidism

Contact Info

Product

Resources

About