title: Intraoperative decay profile of intact (1-84) parathyroid hormone in surgery for renal hyperparathyroidism--a consecutive series of 80 patients.
abstract: BACKGROUND
  The utility of intraoperative parathyroid hormone (PTH) monitoring is unclear in the surgical management of renal hyperparathyroidism. Our goal was to define the normal pattern of decay during operation for renal hyperparathyroidism by using the rapid intact (1-84) parathyroid hormone (PTH) assay.
  
  
  METHODS
  Eighty consecutive patients underwent neck exploration for renal hyperparathyroidism. Intact PTH levels were monitored with a rapid immunochemiluminometric assay. Samples were assayed at the induction of anesthesia, after dissection before resection, and 20 and 40 minutes after resection. Follow-up ranged from 3 to 24 months.
  
  
  RESULTS
  Twenty minutes after resection, PTH levels remained many-fold supranormal. Seventy-seven patients (96%) were cured. Of these, 75 patients (94%) had PTH decay of more than 50% from the preoperative level; 74 (99%) were cured. Only 1 of 3 patients (33%) in whom the PTH level decreased less than 40% from the preoperative level was cured. Two patients had intermediate values and both were cured.
  
  
  CONCLUSIONS
  The intraoperative decay of PTH during operation for renal hyperparathyroidism is slower than for patients with normal renal function. However, 20 minutes after resection, a decline to less than 50% of the preoperative level predicts cure, while a level greater than 60% predicts failure.
authors: Surgical Professorial Unit, General and Endocrine Surgery, University of Lille, France.
authors: J
authors: J
authors: Lokey
authors: F
authors: F
authors: Pattou
authors: A
authors: A
authors: Mondragon-Sanchez
authors: M
authors: M
authors: Minuto
authors: B
authors: B
authors: Mullineris
authors: F
authors: F
authors: Wambergue
authors: P
authors: P
authors: Foissac-Geroux
authors: C
authors: C
authors: Noel
authors: H L
authors: HL
authors: de Sagazan
authors: P
authors: P
authors: VanHille
authors: C A
authors: CA
authors: Proye
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy
chemical_list: D010281:Parathyroid Hormone