Use of a Rapid Intraoperative Parathyroid Hormone Assay in the Surgical Management of Parathyroid Disease

Patel, Priya; Pellitteri, Phillip K.; Patel, Niketu M.; Fleetwood, Mildred K.

doi:10.1001/archotol.124.5.559

Cited by 47 publications

(24 citation statements)

References 9 publications

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“…Use of preexcision samples has been suggested to reduce the number of false-negative results in patients with a single adenoma (33,42 ). Timing of postexcision samples is generally at 5 and/or 10 min, although timings of 7 and 20 min have been used in reported studies (44,45 ). A recent protocol has suggested that an immediate post-gland excision sample may also be useful (46 ).…”

Section: Interpretation Of Rapid Intraoperative Pth Assay Resultsmentioning

confidence: 99%

Rapid Intraoperative Immunoassay of Parathyroid Hormone and Other Hormones: A New Paradigm for Point-of-Care Testing

2004

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Background:The first description of the use of a rapid assay for the measurement of intact parathyroid hormone (PTH) in patients undergoing parathyroidectomy for hyperparathyroidism was reported in 1988. Subsequent improvements in the analytical performance of the rapid intraoperative PTH assay allowed the establishment of its clinical utility in the surgical management of hyperparathyroidism. These modifications also allowed the assay to be performed in or near the operating suite. Methods: We searched MEDLINE, using the following key words: intraoperative, rapid, quick, parathyroid hormone, hormone, and immunoassay. Relevant articles that focused on the analytical aspects and clinical utility of rapid intraoperative hormone immunoassays were selected for this review. Content: On the basis of the positive impact that the rapid intraoperative PTH test has had on both patient outcomes and cost savings, other rapid intraoperative hormone immunoassays for the diagnosis and/or treatment of other endocrine-hormone-secreting tumors have been developed. These hormones share certain characteristics that make them suitable for use as rapid intraoperative tests, i.e., short analyte half-life and/or large analyte concentration gradient, rapid analysis time, and positive clinical utility. Initial studies with cortisol, gastrin, insulin, adrenocorticotropic hormone, and testosterone have shown promising results in pre-

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Section: Interpretation Of Rapid Intraoperative Pth Assay Resultsmentioning

confidence: 99%

Rapid Intraoperative Immunoassay of Parathyroid Hormone and Other Hormones: A New Paradigm for Point-of-Care Testing

2004

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“…was superior to that of achieving an absolutely normal limit with postexcision levels. Application of the 50% degradation rule to variable time intervals, especially in regard to baseline values (preincision vs. preexcision), has been shown to produce differences in surgical results [67][68][69][70] . Chiu et al [71] applied their institutional IOPTH results to variable interpretation criteria, concluding that utilization of a preincision baseline value and a 10-min postexcision level represented the criteria with the highest predictive value for achieving normocalcemia postoperatively.…”

Section: Methodology and Applicationmentioning

confidence: 99%

The Role of Intraoperative Measurement of Parathyroid Hormone in Parathyroid Surgery

Pellitteri¹

2008

ORL

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Technological developments have significantly contributed to the rapid evolution of the surgical management of parathyroid disorders. The ability to physiologically determine the intraoperative status of the patient is now possible through the assessment of changing levels of intact parathyroid hormone (PTH) during surgery. In most patients with primary hyperparathyroidism, this method provides biochemical confirmation of hyperfunctional gland removal, and is predictive of a eucalcemic state and surgical cure. Patients with renal-induced disease (excluding tertiary hyperparathyroidism) do not follow the same kinetic decline in PTH and are therefore less likely to benefit from this modality. An emerging population of patients with primary disease and lower baseline levels of intact PTH appear to demonstrate a greater likelihood of manifesting multiple gland disease and do not follow a consistently predictable kinetic degradation profile. Although this category of patients will require further investigation, potentially resulting in modification of the utility of intraoperative determination of PTH levels, it is clear that this modality represents a very powerful technique which has significantly enhanced the surgical treatment of parathyroid disease.

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“…The rapid intra-operative parathyroid hormone assay (RI-PTH) is transforming the parathyroidectomy procedure. The visualization of all parathyroids glands and resection of apparently enlarged gland(s) has increasingly been replaced by minimally invasive (unilateral) surgical procedures (MIP), supported by pre-operative imaging aid and RI-PTH measurements [2][3][4][5][6][7][8][9][10]. In most cases, the improved imaging techniques enable exact pre-operative localization of the parathyroid adenoma [11].…”

Section: Introductionmentioning

confidence: 99%

Parathyroidectomy monitored by intra-operative PTH: The relevance of the 20 min end-point

Stasio

Carrozza

Lombardi

et al. 2007

Clinical Biochemistry

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Use of a Rapid Intraoperative Parathyroid Hormone Assay in the Surgical Management of Parathyroid Disease

Cited by 47 publications

References 9 publications

Rapid Intraoperative Immunoassay of Parathyroid Hormone and Other Hormones: A New Paradigm for Point-of-Care Testing

Rapid Intraoperative Immunoassay of Parathyroid Hormone and Other Hormones: A New Paradigm for Point-of-Care Testing

The Role of Intraoperative Measurement of Parathyroid Hormone in Parathyroid Surgery

Parathyroidectomy monitored by intra-operative PTH: The relevance of the 20 min end-point

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