Intraoperative parathyroid hormone in strategy of surgical treatment of a primary hyperparathyreosis

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Problem of surgical treatment of patients with a primary hyperparathyreosis – normalisation of level of a parathyroid hormone and calcium after operation. Any of diagnostics methods before operation does not allow to prognosticate authentically necessary volume of an operative measure in each specific case in this connection, was considered obligatory bilateral intraoperative revision of regions of a typical locating of parathyroids. Appearance of a method of definition of an quick parathyroid hormone during operation has allowed to estimate adequacy of a surgical intervention already on an operating table. Besides, it is a method allows to minimise an operational trauma and duration of a surgical intervention, and also widely to use the video-assisted operative measures in treatment of a primary hyperparathyreosis. We make the retrospective analysis of results of definition intraoperative parathyroid hormone at 230 patients with the primary hyperparathyreosis, operated in Endocrinologic centre of science in Moscow (Russia) from 2006 for 2009. Depending on success of the operative measure, all patients are parted on 4 bunches, according to the received results of concordance and research discordance. The analysed results have shown high sensitivity (93.3%), high specificity (85.7%), and also high predictive value of a positive take (99.5%) definitions intraoperative parathyroid hormone that allows to be oriented on its indexes at a choice of operational strategy in surgical treatment of a primary hyperparathyreosis.

About the authors

N S Kuznetsov

I V Kim


S N Kuznetsov


  1. Duh Q.I., Clark O.H. Surgical approach to hyperparathyroidism (bilateral approach). In: Textbook of Endocrine Surgery, ed. 1, ch. 44. Eds O.-H. Clark, Q.-I. Duh. Philadelphia, PA: WB Saunders, 1997. 357–363.
  2. Chen H., Zeiger M.A., Gordon Ta, Udelsman R. Parathyroidectomy in Maryland: effects on an endocrine center. Surgery 1996; 120: 948–953.
  3. Eigelberger M.S., Clark O.H. Surgical approaches to primary hyperparathyroidism. Endocrinol. Metab. Clin. N. Am. 2000; 29: 479–502.
  4. Sosa J.A., Powe N.R., Levine M.A. et al. Profile of a clinical practice: thresholds for surgery and surgical outcomes for patients with primary hyperparathyroidism: a national survey of endocrine surgeons. J. Clin. Endocrinol. Metab. 1998; 83: 2658–2665.
  5. Nussbaum S.R., Thomson A.R., Hutcheson K.A. et al. Intraoperative measurement of parathyroid hormone in the surgical management of hyperparathyroidism. Surgery 1988; 104: 1121–1127.
  6. Irvin G.L., Dembrow V.D., Prudhomme D.L. Operative monitoring of parathyroid gland hyperfunction. Am. J. Surg. 1991; 162: 299–302.
  7. Molinari A.S., Irvin G.L., Deriso G.T. et al. Incidence of multiglandular disease in primary hyperparathyroidism determined by parathyroid hormone secretion. Surgery 1996; 120: 934–937.
  8. Sokoll L.J., Drew H., Udelsman R. Intraoperative parathyroid hormone analysis: a study of 200 consecutive cases. Clin. Chem. 2000; 46: 1662–1668.
  9. Miccoli P., Berti P., Conte M. et al. Minimally invasive videoassisted parathyroidectomy: lesson learned from 137 cases. J. Am. Coll. Surg. 2000; 191:613–618.
  10. Carty S.E., Worsey J., Virji M.A. et al. Concise parathyroidectomy: the impact of preoperative SPECT 99m-Tc-sestamibi scanning and intraoperative quick parathormone assay. Surgery 1997; 122:1107–1116.
  11. Garner S.C., Leight G.S. Jr. Initial experience with intraoperative PTH determinations in the surgical management of 130 consecutive cases of primary hyperparathyroidism. Surgery 1999; 126: 1132–1138.
  12. Cotran R.S., Kumar V., Robbins S.L. The endocrine system. In: Cotran R.S., Kumar V., Robbins S.L., eds. Robbins Pathologic Basis of Disease. 5th ed. Philadelphia, Pa: WB Saunders Co., 1994. 1125–1128.
  13. Bringhurst F.R., Demay M.B., Kronenberg H.M. Hormones and disorders of mineral metabolism. In: Wilson J.D., Foster D.W., Kronenberg H.M., Larsen P.R., eds. Williams Textbook of Endocrinology. 9th ed. Philadelphia, Pa: WB Saunders Co., 1998:ch. 24.
  14. Bailie G.R. Why do different PTH assays give different results? Medfacts Drug. Inf. Dial. Units. 2000; 2:1–2.
  15. Endres D.B., Rude R.K. Mineral and bone metabolism. In: Burtis C.A., Ashwood E.R., eds. Tietz Textbook of Clinical Chemistry. 3rd ed. Philadelphia, Pa: WB Saunders Co., 1999. 1349–1457.
  16. Bergenfelz A., Ahr en B. Intraoperative secretion of intact parathyroid hormone and aminoterminal parathyroid hormone fragments from normal parathyroid glands associated with solitary parathyroid adenoma. World J. Surg. 1997; 21: 30–35.
  17. Brossard J.H., Cloutier M., Roy L. et al. Accumulation of a non-(1-84) molecular form of parathyroid hormone (PTH) detected by intact PTH assay in renal failure: importance in the interpretation of PTH values. J. Clin. Endocrinol. Metab. 1996; 81: 3923–3929.
  18. Goltzman D., Gomolin H., DeLean A. et al. Discordant disappearance of bioactive and immunoreactive parathyroid hormone after parathyroidectomy. J. Clin. Endocrinol. Metab. 1984; 58: 70–75.
  19. Tonelli F., Spini S., Tommasi M. et al. Intraoperative parathormone measurement in patients with multiple endocrine neoplasia type I syndrome and hyperparathyroidism. World J. Surg. 2000; 24: 556–563.
  20. Lepage R., Roy R., Brossard J.H. et al. A non-(1-84) circulating parathyroid hormone (PTH) fragment interferes significantly with intact PTH commercial assay measurements in uremic samples. Clin. Chem. 1998; 44: 805–809.
  21. Juppner H., Potts J.T. Jr. Immunoassays for the detection of parathyroid hormone. J. Bone Miner. Res. 2002; 17: N81–86.
  22. John M.R., Goodman W.G., Gao P. et al. A novel immunoradiometric assay detects full-length human PTH but not aminoterminally truncated fragments: implications for PTH measurements in renal failure. J.Clin. Endocrinol. Metab. 1999; 84: 4287–4290.
  23. Brown R.C., Aston J.P., Weeks I., Woodhead J.S. Circulating intact parathyroid hormone measured by a two-site immunochemiluminometric assay. J. Clin. Endocrinol. Metab. 1987; 65: 407–414.
  24. Locchi F., Tommasi M., Brandi M. L. et al. The importance of the unsuppressed glands in the study of intact parathyroid hormone disappearance after parathyroid adenomectomy. Eur. J. Endocrinol. 2001; 144: 353–362.
  25. Davies C., Demeure M.J., John A.St., Edis A.J. Study of intact (1-84) parathyroid hormone secretion in patients undergoing parathyroidectomy. World J. Surg. 1990; 14: 355–360.
  26. Brasier A.R., Wang C., Nussbaum S.R. Recovery of parathyroid hormone secretion after parathyroid adenomectomy. J. Clin. Endocrinol. Metab. 1988; 66: 495–500.
  27. Bailie G.R. Why do different PTH assays give different results? Medfacts Drug. Inf. Dial. Units 2000; 2:1–2.
  28. Udelsman R., Donovan P.I., Sokoll L. One hundred consecutive minimally invasive parathyroid explorations. Ann. Surg. 2000; 232: 331–339.
  29. Bergenfelz A., Isaksson A., Lindblom P. et al. Measurement of parathyroid hormone in patients with primary hyperparathyroidism undergoing first and reoperative surgery. Br. J. Surg. 1998; 85: 1129–1132.
  30. Proye C.A., Goropoulos A., Franz C. et al. Usefulness and limits of quick intraoperative measurements of intact (1-84) parathyroid hormone in surgical management of hyperparathyroidism: sequential measurements in patients with multiglandular disease. Surgery. 1991; 110: 1035–1042.
  31. Irvin G.L. 3rd , Deriso G.T. 3rd. A new practical intraoperative parathyroid hormone assay. Am. J. Surg. 1994; 168: 466–468.
  32. Carneiro D.M., Irvin G.L. New point-of-care intraoperative parathyroid hormone assay for intraoperative guidance in parathyroidectomy. World J. Surg. 2002; 26: 1074–1077.
  33. Carneiro D.M., Irvin G.L. Late parathyroid function after successful parathyroidectomy guided by intraoperative hormone assay (QPTH) compared with the standard bilateral neck exploration. Surgery 2000; 128: 925–929.
  34. Inabnet W.B. 3rd, Dakin G.F., Haber R.S. et al. Targeted parathyroidectomy in the era of intraoperative parathormone monitoring. World J. Surg. 2002; 26: 921–925.
  35. Vignali E., Picone A., Materazzi G. et al. A quick intraoperative parathyroid hormone assay in the surgical management of patients with primary hyperparathyroidism: a study of 206 consecutive cases. Eur. J. Endocrinol. 2002; 146: 783–738.
  36. Hallfeldt K.K., Trupka A., Gallwas J. et al. Minimally invasive video-assisted parathyroidectomy and intraoperative parathyroid hormone monitoring: the first 36 cases and some pitfalls. Surg. Endosc. 2002; 16: 1759–1763.
  37. Agarwal G., Barakate M.S., Robinson B. et al. Intraoperative quick parathyroid hormone versus same-day parathyroid hormone testing for minimally invasive parathyroidectomy: a cost-effectiveness study. Surgery 2001; 130: 963–970.
  38. Mandell D.L., Genden E.M., Mechanick J.I. et al. The influence of intraoperative parathyroid hormone monitoring on the surgical management of hyperparathyroidism. Arch. Otolaryngol. Head Neck Surg. 2001; 127: 821–827.
  39. Jaskowiak N.T., Sugg S.L., Helke J. et al. Pitfalls of intraoperative quick parathyroid hormone monitoring and gamma probe localization in surgery for primary hyperparathyroidism. Arch. Surg. 2002; 137: 659–668.
  40. Trupka A., Hallfeldt K., Horn K. et al. Intraoperative monitoring of intact parathyroid hormone (iPTH) in surgery of primary hyperparathyroidism with a new rapid test. Chirurgia 2001; 72: 578–583.
  41. Hallfeldt K., Trupka A., Gallwas J. et al. Intraoperative monitoring of intact parathyroid hormone during surgery for primary hyperparathyroidism. Zentralbl. Chir. 2002; 127: 448–452.
  42. Libutti S.K., Alexander H.R., Sampson M.L. et al. Kinetic analysis of the rapid intraoperative parathyroid hormone assay in patients during operation for hyperparathyroidism. Surgery 1999; 126: 1145–1150.
  43. Mozzon M., Pierre-E Mortier, Paul M. Jacob et al. Surgical Management of Primary Hyperparathyroidism: The Case for Giving up Quick Intraoperative PTH Assay in Favor of Routine PTH Measurement the Morning After. Ann. Surg. 2004;240 (6): 949–954.
  44. Miura D., Wada N., Arici C. et al. Does intraoperative quick PTH assay improve the results of parathyroidectomy? World J. Surg. 2002; 26: 926.



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