title: Initial experience with intraoperative PTH determinations in the surgical management of 130 consecutive cases of primary hyperparathyroidism.
abstract: 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.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: S C
authors.initials: SC
authors.lastname: Garner
authors.forename: G S
authors.initials: GS
authors.lastname: Leight
mesh_terms: D000236:Adenoma / Q000097:blood / Q000453:epidemiology / Q000601:surgery; D000328:Adult; D000368:Aged; D002624:Chemistry, Clinical / Q000592:standards; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood* / Q000453:epidemiology / Q000601:surgery*; D015592:Immunoradiometric Assay; D015994:Incidence; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D010282:Parathyroid Neoplasms / Q000097:blood / Q000453:epidemiology / Q000601:surgery; D016105:Parathyroidectomy; D011237:Predictive Value of Tests; D015203:Reproducibility of Results
chemical_list: D010281:Parathyroid Hormone