Role and Recent Trend of Intraoperative Parathyroid Hormone Monitoring During Parathyroidectomy in Patients With Primary Hyperparathyroidism

Ahn, Dongbin; Kwak, Ji Hye

doi:10.3342/kjorl-hns.2022.00332

Cited by 4 publications

(6 citation statements)

References 31 publications

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“…In this study, IO-PTH confirmed surgical success of focused parathyroidectomy in all cases (100%) and highlights the accuracy of the Miami criterion for predicting surgical cure. This is higher than that reported in other studies (97–98%) [ 9 , 17 ] and may largely be explained by having a highly experienced, dedicated parathyroid surgeon. However, IO-PTH was only done in one third of the surgical group, highlighting the need to confirm this in a larger group and to evaluate emerging alternate criteria [ 9 , 17 – 19 ].…”

Section: Discussioncontrasting

confidence: 71%

“…This is higher than that reported in other studies (97–98%) [ 9 , 17 ] and may largely be explained by having a highly experienced, dedicated parathyroid surgeon. However, IO-PTH was only done in one third of the surgical group, highlighting the need to confirm this in a larger group and to evaluate emerging alternate criteria [ 9 , 17 – 19 ].…”

Section: Discussioncontrasting

confidence: 71%

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Characteristics, management and outcomes of primary hyperparathyroidism from 2009 to 2021: a single centre report from South Africa

Govind,

Paruk,

Motala

2024

BMC Endocr Disord

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Background There has been a notable shift towards the diagnosis of less severe and asymptomatic primary hyperparathyroidism (PHPT) in developed countries. However, there is a paucity of recent data from sub-Saharan Africa (SSA), and also, no reported data from SSA on the utility of intra-operative parathyroid hormone (IO-PTH) monitoring. In an earlier study from Inkosi Albert Luthuli Central Hospital (IALCH), Durban, South Africa (2003–2009), majority of patients (92.9%) had symptomatic disease. The aim of this study was to evaluate the clinical profile and management outcomes of patients presenting with PHPT at IALCH. Methods A retrospective chart review of patients with PHPT attending the Endocrinology clinic at IALCH between July 2009 and December 2021. Clinical presentation, laboratory results, radiologic findings, surgical notes and histology were recorded. Results Analysis included 110 patients (87% female) with PHPT. Median age at presentation was 57 (44; 67.5) years. Symptomatic disease was present in 62.7% (n:69); 20.9% (n:23) had a history of nephrolithiasis and 7.3% (n:8) presented with previous fragility fractures. Mean serum calcium was 2.87 ± 0.34 mmol/l; median serum-PTH was 23.3 (15.59; 45.38) pmol/l, alkaline phosphatase 117.5 (89; 145.5) U/l and 25-hydroxyvitamin-D 42.9 (33.26; 62.92) nmol/l. Sestamibi scan (n:106 patients) identified an adenoma in 83.02%. Parathyroidectomy was performed on 84 patients with a cure rate of 95.2%. Reasons for conservative management (n:26) included: no current surgical indication (n:7), refusal (n:5) or deferral of surgery (n:5), loss to follow-up (n:5) and assessed as high anaesthetic risk (n:4). IO-PTH measurements performed on 28 patients indicated surgical success in 100%, based on Miami criteria. Histology confirmed adenoma in 88.1%, hyperplasia in 7.1% and carcinoma in 4.8%. Post-operative hypocalcaemia developed in 30 patients (35.7%), of whom, 14 developed hungry bone syndrome (HBS). In multivariate analysis, significant risk factors associated with HBS included male sex (OR 7.01; 95% CI 1.28, 38.39; p 0.025) and elevated pre-operative PTH (OR 1.01; 95% CI 1.00, 1.02; p 0.008). Conclusions The proportion of asymptomatic PHPT has increased at this centre over the past decade but symptomatic disease remains the dominant presentation. Parathyroidectomy is curative in the majority of patients. IO-PTH monitoring is valuable in ensuring successful surgery.

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Section: Discussioncontrasting

confidence: 71%

Section: Discussioncontrasting

confidence: 71%

Characteristics, management and outcomes of primary hyperparathyroidism from 2009 to 2021: a single centre report from South Africa

Govind,

Paruk,

Motala

2024

BMC Endocr Disord

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show abstract

“…In this study, IO-PTH con rmed surgical success of focused parathyroidectomy in all cases (100%) and highlights the accuracy of the Miami criterion for predicting surgical cure. This is higher than that reported in other studies (97-98%) (9,17) and may largely be explained by having a highly experienced dedicated parathyroid surgeon. However, IO-PTH was only done in one third of the surgical group, highlighting the need to con rm this in a larger group and to evaluate emerging alternate criteria (9,(17)(18)(19).…”

Section: Discussioncontrasting

confidence: 71%

“…This is higher than that reported in other studies (97-98%) (9,17) and may largely be explained by having a highly experienced dedicated parathyroid surgeon. However, IO-PTH was only done in one third of the surgical group, highlighting the need to con rm this in a larger group and to evaluate emerging alternate criteria (9,(17)(18)(19).…”

Section: Discussioncontrasting

confidence: 71%

Characteristics, Management and Outcomes of Primary Hyperparathyroidism from 2009 to 2021: a single centre report from South Africa.

Govind,

Paruk,

Motala

2024

Preprint

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Background: There has been a notable shift towards the diagnosis of less severe and asymptomatic primary hyperparathyroidism (PHPT) in developed countries. However, there is a paucity of recent data from sub-Saharan Africa (SSA), and also, no reported data from SSA on the utility of intra-operative parathyroid hormone (IO-PTH) monitoring. In an earlier study from Inkosi Albert Luthuli Central Hospital (IALCH), Durban, South Africa (2003–2009), majority of patients (92.9%) had symptomatic disease. The aim of this study was to evaluate the clinical profile and management outcomes of patients presenting with PHPT at IALCH.Methods: A retrospective chart review of patients with PHPT attending the Endocrinology clinic at IALCH between July 2009 and December 2021. Clinical presentation, laboratory results, radiologic findings, surgical notes and histology were recorded.Results: Analysis included 110 patients (87% female) with PHPT. Median age at presentation was 57 (44; 67.5) years. Symptomatic disease was present in 62.7% (n:69); 20.9% (n:23) had a history of nephrolithiasis and 7.3% (n:8) presented with previous fragility fractures. Mean serum calcium was 2.87 ± 0.34 mmol/l; median serum-PTH was 23.3 (15.59;45.38) pmol/l, alkaline phosphatase 117.5 (89;145.5) U/l and 25-hydroxyvitamin-D 42.9 (33.26;62.92) nmol/l. Sestamibi scan (n:106 patients) identified an adenoma in 83.02%. Parathyroidectomy was performed on 84 patients with a cure rate of 95.2%. Reasons for conservative management (n:26) included: no current surgical indication (n:7), refusal (n:5) or deferral of surgery (n:5), loss to follow-up (n:5) and assessed as high anaesthetic risk (n:4). IO-PTH measurements performed on 28 patients indicated surgical success in 100%, based on Miami criteria. Histology confirmed adenoma in 88.1%, hyperplasia in 7.1% and carcinoma in 4.8%. Post-operative hypocalcaemia developed in 30 patients (35.7%), of whom, 14 developed hungry bone syndrome (HBS). In multivariate analysis, significant risk factors associated with HBS included male sex (OR 7.01; 95% CI 1.28, 38.39; p 0.025) and elevated pre-operative PTH (OR 1.01; 95% CI 1.00, 1.02; p 0.008)Conclusions: The proportion of asymptomatic PHPT has increased at this centre over the past decade but symptomatic disease remains the dominant presentation. Parathyroidectomy is curative in the majority of patients. IO-PTH monitoring is valuable in ensuring successful surgery.

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“…In 2016, the American Association of Endocrine Surgeons (AAES) strongly recommended the use of IOPTH in minimally invasive parathyroidectomy to reduce operative failure [1]. Furthermore, it has been suggested that IOPTH monitoring may be helpful in guiding challenging parathyroid surgery such as in cases of parathyroid hyperplasia and tertiary hyperparathyroidism [20, 21]. Outside of primary hyperparathyroidism, however, there is little standardization and consensus in the utility of IOPTH monitoring.…”

Section: Discussionmentioning

confidence: 99%

Trends in using intraoperative parathyroid monitoring during parathyroidectomy: Protocol and rationale for a cross-sectional survey study of North American surgeons

Staibano,

McKechnie,

Thabane

et al. 2024

Preprint

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Introduction Hyperparathyroidism is a common endocrine disorder that can be secondary to a single or multiple abnormal parathyroid glands and can occur in the context of chronic kidney disease (CKD). There are three types of hyperparathyroidism, and all are definitively managed via surgical extirpation of abnormal parathyroid gland tissue. Intraoperative parathyroid hormone (IOPTH) monitoring was introduced over three decades ago and has been shown to improve clinical outcomes in patients with primary hyperparathyroidism (PHPT). As the incidence of PHPT rises due to improving screening globally and the incidence of CKD rises, it will be important to optimize adoption and standardization of IOPTH within endocrine surgery centers around the world. We will perform a cross-sectional survey study of surgeon rationale, operational details, and barriers associated with IOPTH adoption across North America. Methods and analysis We will utilize a convenience sampling technique to distribute an online survey to head and neck surgeons and endocrine surgeons across North America. This survey will be distributed via email to three North American professional societies (i.e., Canadian Society for Otolaryngologists–Head and Neck Surgeons, American Head and Neck Society, and American Association of Endocrine Surgeons). The survey will consist of 30 multiple choice questions that are divided into three concepts: (1) participant demographics and training details, (2) details of surgical adjuncts during parathyroidectomy, and (3) barriers to adoption of IOPTH. Descriptive analyses and multiple logistic regression models will be used to evaluate the impact of demographic, institutional, and training variables on the use of IOPTH monitoring and barriers to IOPTH adoption. Discussion This study will explore IOPTH monitoring for guiding parathyroid surgeries in secondary and tertiary hyperparathyroidism. An ability to capture surgeon practices regarding IOPTH monitoring will inform trials aimed to help optimize IOPTH in challenging populations. Ethics and dissemination Ethics approval was obtained by the Hamilton Integrated Research Ethics Board (2024-17173-GRA). We do not expect any survey respondents to experience any harms because of participating in this study. We plan to present the results of this study at national and international conferences, and we will publish these findings in peer-reviewed surgical journals. We plan to use these study findings to advocate for adoption of IOPTH technologies and inform future studies and trials.

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Role and Recent Trend of Intraoperative Parathyroid Hormone Monitoring During Parathyroidectomy in Patients With Primary Hyperparathyroidism

Cited by 4 publications

References 31 publications

Characteristics, management and outcomes of primary hyperparathyroidism from 2009 to 2021: a single centre report from South Africa

Characteristics, management and outcomes of primary hyperparathyroidism from 2009 to 2021: a single centre report from South Africa

Characteristics, Management and Outcomes of Primary Hyperparathyroidism from 2009 to 2021: a single centre report from South Africa.

Trends in using intraoperative parathyroid monitoring during parathyroidectomy: Protocol and rationale for a cross-sectional survey study of North American surgeons

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