Initial experience with intraoperative PTH determinations in the surgical management of 130 consecutive cases of primary hyperparathyroidism.

Journal Article (Clinical Trial;Journal Article)

BACKGROUND: Successful surgical management of primary hyperparathyroidism (1 degree HPT) historically has required bilateral neck exploration. The intraoperative parathyroid hormone (IO-PTH) assay allows a more limited procedure by confirming complete removal of hypersecreting tissue. METHODS: Plasma samples were obtained from 130 consecutive patients both before (preincision and preexcision baselines) and at approximately 5 and 10 minutes (and additional times) after removal of abnormal parathyroid tissue. Samples were assayed for IO-PTH by a rapid, two-site immunochemiluminescent assay (ICMA) with a 7-minute incubation at 45 degrees C. RESULTS: Plasma IO-PTH decreased by at least 50% in 126 of 130 cases; however, three of these cases were false positives. The four cases in which IO-PTH fell < 50% were classified as two true negatives and two false negatives. A single adenoma was removed in 125 cases, and two or three hyperplastic glands were removed in five cases. CONCLUSIONS: IO-PTH predicted the postoperative outcome in 125 of 130 cases (96.2%), including two of five cases in which multiple hyperplastic glands were removed, and 1 degree HPT was successfully treated in 97.7% (127/130) of the cases. The IO-PTH procedure can provide valuable confirmation to the endocrine surgeon; however, other sources of information must also be used to ensure that all hyperplastic glands are identified.

Full Text

Duke Authors

Cited Authors

  • Garner, SC; Leight, GS

Published Date

  • December 1999

Published In

Volume / Issue

  • 126 / 6

Start / End Page

  • 1132 - 1137

PubMed ID

  • 10598198

International Standard Serial Number (ISSN)

  • 0039-6060

Digital Object Identifier (DOI)

  • 10.1067/msy.2099.101429


  • eng

Conference Location

  • United States