The impact of vitamin D status and tumor size on the intraoperative parathyroid hormone dynamics in patients with symptomatic primary hyperparathyroidism

Agarwal, Gaurav; Sadacharan, Dhalapathy; Ramakant, Pooja; Shukla, Manoj Kumar; Mishra, Shailendra Kumar

doi:10.1007/s00595-011-0113-5

Cited by 6 publications

(7 citation statements)

References 19 publications

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“…We also found a significant drop in IOPTH regardless of 25(OH)D classes. e drop in PTH 3G was significantly and inversely correlated with 25(OH)D, a finding that is in line with the Agarwal et al study [11], but the small effect size precludes any meaningful inference, noting that in univariate F tests following MANCOVA (Table 3), the effect of 25(OH)D was not found to be significant.…”

Section: Discussionsupporting

confidence: 78%

“…However, results of studies looking at the impact of 25(OH)D status on IOPTH kinetics are controversial. While one study has shown an inverse relationship between 25(OH)D levels and IOPTH decline [11], others did not find the same results [12,13,[33][34][35]. We also found a significant drop in IOPTH regardless of 25(OH)D classes.…”

Section: Discussioncontrasting

confidence: 60%

“…e IOPTH value drawn at 10 minutes following parathyroidectomy is the most accurate predictor of a successful MIP [6,7]. Age, impaired renal function [8], race (African American vs. others) [9], and high BMI [10] were shown to be negative predictors of IOPTH decline following MIP, while low 25 hydroxyvitamin D (25(OH)D) levels have been shown to either increase IOPTH drop [11] or have no effect [12,13].…”

Section: Introductionmentioning

confidence: 99%

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Comparison between Second- and Third-Generation PTH Assays during Minimally Invasive Parathyroidectomy (MIP)

Gannagé‐Yared

Younes

Azzi

et al. 2020

International Journal of Endocrinology

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Context. Intraoperative PTH (IOPTH) drop of more than 50% during minimally invasive parathyroidectomy (MIP) predicts the surgery success. Comparison between second-and third-generation PTH assays (PTH 2G and PTH 3G) on IOPTH decline is scarce. e aim of this study is to compare both assays and to determine the predictors of IOPTH decline. Methods. 112 patients (of which 72.3% females) underwent MIP by the same surgeon. Age, sex, body mass index (BMI), pre-and postoperative serum calcium, creatinine, 25(OH)D levels, PTH at baseline (PTH T0), and PTH at 10 minutes after adenoma resection (PTH T10) were recorded. Both PTH 2G and PTH 3G assays were assessed using the Diasorin assays. Results. e mean age was 56.1 ± 14.7 years. Mean value of BMI, preoperative calcium, 25(OH)D, and CKD-EPI-eGFR were, respectively, 26.8 ± 4.8 kg/m 2 , 110.9 ± 7.9 mg/L, 19.3 ± 9.2 ng/mL, and 88.6 ± 25.6 mL/min/1.73 m 2 . PTH 2G and PTH 3G assays were well correlated at PTH T0 and PTH T10 (respectively, correlation coefficient 0.74 and 0.72 for intraclass correlation type 3). e median PTH fall was, respectively, of 79.9% and 82.5% for PTH 2G and PTH 3G. Multivariate analysis using the combined PTH 2G and PTH 3G as a dependent variable with 2 repeated measurements (at PTH 0 and PTH 10) showed a significant effect of preoperative calcium on IOPTH fall (p � 0.001, effect size 0.13), while no significant effects were observed for sex, age, BMI, and 25(OH)D. Conclusion. PTH 2G and PTH 3G assays resulted in a similar drop in IOPTH values. Elevated preoperative calcium levels are the only independent predictor of IOPTH decline. Further studies are needed to determine other factors that can influence PTH kinetics.

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Section: Discussionsupporting

confidence: 78%

Section: Discussioncontrasting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

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Comparison between Second- and Third-Generation PTH Assays during Minimally Invasive Parathyroidectomy (MIP)

Gannagé‐Yared

Younes

Azzi

et al. 2020

International Journal of Endocrinology

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“…Indeed, when the parathyroid adenoma is larger, there is a bigger chance that the lesion is solitary, or at least not hyperplastic (10,24,28), although a larger parathyroid adenoma may sometimes mask the presence of a second, smaller adenoma (18). The concordance of an accurate preoperative localization and high preoperative PTH values with the excision of a large adenoma and a rapid decrease of PTH makes the presence of a solitary adenoma very likely (21,22). Some authors describe the increase of postoperative hypocalcemia risk with larger parathyroid adenomas (6,24) and lower vitamin D levels (14,31), whereas others did not observe this relationship (16,18).…”

Section: Discussionmentioning

confidence: 99%

“…There is a wide variation in the dimensions of parathyroid adenomas (8). It is yet not clear whether the dimensions of parathyroid adenomas may influence the sensitivity or specificity of localization techniques (9)(10)(11)(12)19), or whether this information may be of value for predicting disease severity (6,8,13,15,20) or evolution after surgery (6,8,(13)(14)(15)(16)(17)(18)(19)(21)(22)(23)(24)(25). The dimensions of parathyroid adenomas were correlated in different studies with various parameters related to calcium and bone metabolism, such as PTH (6,7,14,15,20,(24)(25)(26)(27)(28)(29)(30), calcium (6-8, 13, 15, 17, 24-30), 25OHD3 (14)(15)(16)18,25,29,31) or FGF23 (32), but also other biological, histological or genetic findings…”

Section: Introductionmentioning

confidence: 99%

The Volume of Solitary Parathyroid Adenoma is Related to Preoperative PTH and 250H-D3, but Not to Calcium Levels

et al. 2017

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Purpose. To correlate the volume of parathyroid adenomas with the hormonal and metabolic profile at patients diagnosed with primary hyperparathyroidism (pHPTH). Patients and Methods. Cross-sectional multicentric study, enrolling 52 patients with pHPTH from two medical institutions. Serum calcium and PTH were evaluated in all patients before surgery, whereas 25OHD3 was measured only in the 33 patients recruited form one medical unit. The volume of parathyroid adenoma was measured by using the formula of a rotating ellipsoid. Results. We observed a significant correlation of the volume of parathyroid adenomas with PTH at patients from the two units and in the whole group (p < 0.0001), but not with serum calcium (p = 0.494). Twenty-five out of the 33 patients at whom 25OHD3 was measured had levels in the range of deficiency. 25OHD3 was not correlated with PTH or calcium levels, but was negatively correlated to the adenoma volume and positively to the PTH/volume ratio (p = 0.041 and p = 0.048, respectively). Conclusions. The volume of parathyroid adenoma seems to be related to preoperative PTH and 25OHD3, but not to calcium level. Vitamin D deficiency is frequently found at patients with pHPTH and may contribute to particular disease profiles, including larger parathyroid adenomas.

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Intraoperative Parathyroid Hormone Monitoring Criteria in Primary Hyperparathyroidism

Staibano,

Au,

Zhang

et al. 2024

JAMA Otolaryngol Head Neck Surg

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ImportanceIntraoperative parathyroid hormone (IOPTH) monitoring is recommended by the American Association of Endocrine Surgeons for use during parathyroidectomy for patients with primary hyperparathyroidism (PHPT), but there is no clinician consensus regarding the IOPTH monitoring criteria that optimize diagnostic accuracy.ObjectiveTo evaluate and rank the diagnostic properties of IOPTH monitoring criteria used during surgery for patients with PHPT.Data SourcesA bayesian diagnostic test accuracy network meta-analysis (DTA-NMA) was performed, in which peer-reviewed citations from January 1, 1990, to July 22, 2023, were searched for in MEDLINE, Embase, Web of Science, CENTRAL, and CINAHL.Study SelectionAll full-text study designs that evaluated any IOPTH monitoring criteria as a diagnostic test were included in this meta-analysis. Any studies evaluating adult patients diagnosed with PHPT undergoing parathyroidectomy were also included. The reference standard used in this study was normalization of calcium and/or parathyroid hormone levels within 1 year of surgery.Data Extraction and SynthesisThis DTA-NMA was reported in accordance with the applicable Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Two reviewers evaluated all abstracts and full-text articles using a piloted extraction form. A third author resolved any conflicts. There are no published Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) resources for DTA-NMA. The following conventional monitoring criteria were included: Halle, Miami, Rome, Vienna, and PTH normalization, and the following modified criteria were included: Miami and PTH normalization, modified Miami, and modified Vienna. A bayesian hierarchical DTA-NMA model with corresponding 95% credible intervals (CrIs) was used to describe the pooled diagnostic characteristics of the evaluated IOPTH monitoring criteria.Main Outcomes and MeasuresMain outcomes included pooled diagnostic test properties, including sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio.ResultsA total of 72 studies, which included 19 072 patients, met the inclusion criteria. Sixty-nine studies (95.8%) investigated classic PHPT. In PHPT, the Miami criteria were investigated most often and had the best diagnostic properties (diagnostic odds ratio, 60.00 [95% CrI, 32.00-145.00]) when compared to other conventional criteria. Moreover, the modified Miami criteria, which measures a postexcision IOPTH level 15 minutes or more postexcision of all hyperfunctioning parathyroid tissue, were the overall best criteria (diagnostic odds ratio, 79.71 [95% CrI, 22.46-816.67]). There was a low risk of study bias and no publication bias.Conclusions and RelevanceThe results of this meta-analysis suggest that surgeons should use the modified Miami criteria when performing IOPTH-guided surgery for patients with PHPT because these criteria optimize intraoperative diagnostic accuracy by minimizing unnecessary neck exploration and revision surgery rates.

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The impact of vitamin D status and tumor size on the intraoperative parathyroid hormone dynamics in patients with symptomatic primary hyperparathyroidism

Abstract: The IOPTH can accurately predict a cure in patients with severe primary hyperparathyroidism. The percentage of decrease in the IOPTH is steeper in patients with lower serum 25-hydroxy vitamin D levels and larger parathyroid tumors.

Cited by 6 publications

References 19 publications

Comparison between Second- and Third-Generation PTH Assays during Minimally Invasive Parathyroidectomy (MIP)

Comparison between Second- and Third-Generation PTH Assays during Minimally Invasive Parathyroidectomy (MIP)

The Volume of Solitary Parathyroid Adenoma is Related to Preoperative PTH and 250H-D3, but Not to Calcium Levels

Intraoperative Parathyroid Hormone Monitoring Criteria in Primary Hyperparathyroidism

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