The Role of Quick Bio-Intact PTH(1-84) Assay During Parathyroidectomy for Secondary Hyperparathyroidism

Ikeda, Yoshifumi; Kurihara, Hiroko; Morita, Naomi; Miyabe, Rika; Takami, Hiroshi

doi:10.1016/j.jss.2006.11.025

Cited by 15 publications

(5 citation statements)

References 24 publications

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“…1 Use of the Technetium 99-m and the radioguidance probe can facilitate identification of hyperfunctioning parathyroid glands including those in ectopic locations and has been shown to decrease overall operative time. [384][385][386] Use of the " > 20% ex vivo count" rule also identifies both hyperplastic and adenomatous parathyroid glands with high sensitivity, and has been suggested as a reliable substitute for frozen section analysis. 337,366,387…”

Section: Probe Radioguidancementioning

confidence: 99%

“…The use of injecting Technetium 99-m as a radioisotope to help localize and confirm hyperfunctioning parathyroid tissue has become a popularly used intraoperative adjunct in PTX for PHPT as described in the AAES guidelines for PHPT 1. Use of the Technetium 99-m and the radioguidance probe can facilitate identification of hyperfunctioning parathyroid glands including those in ectopic locations and has been shown to decrease overall operative time 384–386. Use of the “>20% ex vivo count” rule also identifies both hyperplastic and adenomatous parathyroid glands with high sensitivity, and has been suggested as a reliable substitute for frozen section analysis 337,366,387…”

Section: Other Intraoperative Adjuncts and Nonsurgical Approachesmentioning

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: Probe Radioguidancementioning

confidence: 99%

Section: Other Intraoperative Adjuncts and Nonsurgical Approachesmentioning

confidence: 99%

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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“…As opposed to primary HPT where established protocols exist for ioPTH monitoring, no such protocols have been validated for ESRD-related HPT. This may be in part related to delayed renal clearance of PTH in the ESRD population [ 81 – 83 ]. Intact PTH (iPTH) assays cross-react with PTH fragments, which can experience reduced clearance leading to an overestimation of PTH concentration.…”

Section: Parathyroidectomy As a Treatment For Persistent Post-transplmentioning

confidence: 99%

Management of Post-transplant Hyperparathyroidism and Bone Disease

Santos

Rossi

Coyne

et al. 2019

Drugs

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Significant advances in immunosuppressive therapies have been made in renal transplantation, leading to increased allograft and patient survival. Despite improvement in overall patient survival, patients continue to require management of persistent post-transplant hyperparathyroidism. Medications that treat persistent hyperparathyroidism include vitamin D, vitamin D analogues, and calcimimetics. Medication side effects such as hypocalcemia or hypercalcemia, and adynamic bone disease, may lead to a decrease in the drugs. When medical management fails to control persistent post-transplant hyperparathyroidism, treatment is a parathyroidectomy. Surgical techniques are not uniform between centers and surgeons. Undergoing the surgery may include a subtotal technique or a technique including total parathyroid gland resection with partial heterotopic gland reimplantation. In addition, there are possible post-surgical complications. The ideal treatment for persistent post-transplant hyperparathyroidism is the treatment and prevention of the condition while patients are being managed for their late-stage chronic kidney disease and end-stage renal disease.

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“…61 In comparison to the bioactive fragments, the non-1-84 fragments were reported to have a longer half-life. 62 Given the fact that the latter fragments are known to accumulate in renal failure patients, 63 false results would be likely if second generation assays were used for IPM in such patients. A Bio-Intact PTH (1-84 fragments) measuring assay has, however, been reported to be more…”

Section: Selection Of the Assay Typementioning

confidence: 99%

Quick parathyroid hormone assays: a comprehensive review of their utility in clinical practice

Shawky

2016

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Continuous development of quick parathyroid hormone assays has resulted in a corresponding expansion of their applications in the practical landscape. In-theatre measurement of the parathyroid hormone has long been recognized as a valuable adjunct in parathyroid surgery, with other applications being incorporated in thyroid surgery and out-of-theatre uses. Such widespread utilization of these assays has also brought the concept of point-of-care testing to the endocrine surgical patient. We have herein summarized the established and potential applications of these assays, emphasizing their importance in the point-of-care setting, highlighting the proper selection of the assay type for intraoperative hormone monitoring and spotlighting those applications which should be validated for use in the clinical setting and those which need to be investigated further.

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The Role of Quick Bio-Intact PTH(1-84) Assay During Parathyroidectomy for Secondary Hyperparathyroidism

Cited by 15 publications

References 24 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

Management of Post-transplant Hyperparathyroidism and Bone Disease

Quick parathyroid hormone assays: a comprehensive review of their utility in clinical practice

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