Intraoperative monitoring of intact PTH during surgery for primary hyperparathyroidism

Bergenfelz, A (author): Lund University,Lunds universitet,Kirurgi, Lund,Sektion V,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Surgery (Lund),Section V,Department of Clinical Sciences, Lund,Faculty of Medicine

Isaksson, A (author): Lund University,Lunds universitet,Avdelningen för klinisk kemi och farmakologi,Institutionen för laboratoriemedicin,Medicinska fakulteten,Division of Clinical Chemistry and Pharmacology,Department of Laboratory Medicine,Faculty of Medicine

Ahrén, B (author): Lund University,Lunds universitet,Medicin, Lund,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Diabetes,Forskargrupper vid Lunds universitet,Medicine, Lund,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Lund University Research Groups

(creator_code:org_t)

Abstract Subject headings

The intraoperative differential diagnosis between adenoma and hyperplasia during surgery for primary hyperparathyroidism (pHPT) is sometimes difficult. Several methods have been proposed to aid the surgeon in deciding on the amount of parathyroid tissue to be resected. We examined the use of intraoperative monitoring of intact PTH in 47 patients operated upon for pHPT. The highly sensitive assay for intact PTH was modified to permit a total turn-around time from gland excision to obtained result of about 60 min. The correlation (r) between the results of the modified and the conventional method, which requires 24 h of incubation, was 0.98. At 15 min after removal of the parathyroid adenoma the levels of intact PTH had decreased by [mean (SD)] 85 (11)%. A decrease of 63% in intact PTH in patients with parathyroid adenoma predicted with 95% confidence the 4 patients with primary hyperplasia as not having parathyroid adenoma. We conclude that intraoperative measurement of intact PTH could be a valuable adjunct to surgical skill, especially for reoperative parathyroid surgery.

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