Intraoperative and postoperative PTH secretion mode in patients with hyperparathyroidism.
The development of a sensitive 2-site immunoradiometric assay which detects only intact human PTH (1-84) enabled us to study kinetics of PTH secretion intraoperatively. In a prospective study, we assessed the PTH (1-84) secretion mode intraoperatively in 54 patients with adenomas, in 14 patients with tertiary hyperparathyroidism (HPT), and in 2 patients with persistent HPT. After the removal of adenomatous or hyperplastic tissue, a significant drop of PTH (1-84) concentration was seen. A 50% decrease in the basal PTH concentration was reached significantly earlier for adenomas than for hyperplasias. In the 2 cases with unrevealing neck exploration, the PTH (1-84) concentrations showed hardly any change. The recovery of PTH secretion was studied in 23 patients, 20 of whom had a single adenoma; in 2 cases, a hyperplasia was present and 1 patient showed the clinical signs of a toxic HPT. We found an initial drop of PTH concentration 4 hours postoperatively below the limit of detection and a rapid recovery within 24 hours postoperatively. The PTH concentration values were well within the normal range after 48-72 hours.
Fischer
S
S
Department of Surgery, University of Heidelberg, Federal Republic of Germany.
Flentje
D
D
Kettelhack
C
C
Schmidt-Gayk
J
J
Buhr
H
H
Herfarth
C
C
D000236:Adenoma / Q000097:blood / Q000378:metabolism / Q000601:surgery*; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood / Q000601:surgery*; D015592:Immunoradiometric Assay; D010280:Parathyroid Glands / Q000601:surgery; D010281:Parathyroid Hormone / Q000097:blood / Q000378:metabolism*; D010282:Parathyroid Neoplasms / Q000097:blood / Q000378:metabolism / Q000601:surgery*; D011446:Prospective Studies
D010281:Parathyroid Hormone