Intraoperative monitoring of kinetic total serum calcium levels in primary hyperparathyroidism surgery.
BACKGROUND
In the setting of minimal approach Sestamibi-guided parathyroid surgery for primary hyperparathyroidism we evaluated if total serum calcium level monitoring is as valuable as intraoperative parathyroid hormone (iPTH) monitoring.


METHODS
Prospective open single-blinded efficacy trial of two intraoperative diagnostic monitoring methods (iPTH and total serum calcium level) on a cohort of surgical patients. All patients (n = 35) were undergoing parathyroid surgery at the Department of General Surgery at B Cruces' Hospital, Vizcaya, Spain, between October 1999 and March 2001. Kinetics of serum levels of Ca and iPTH during surgery and time of prediction of cure for each method (measured in the clinic, admission, and intraoperatively, such as induction of anesthesia, and every 5 minutes after removal of adenoma) were analyzed.


RESULTS
Hypercalcemia and iPTH levels became corrected in 34 patients. Average serum calcium levels dropped from pathologic 11.07 +/- 0.41 mg/dL (mean +/- standard deviation) to normal values 9.7 +/- 0.82 mg/dL during the first intraoperative determination (minute 5), but mean iPTH decreased from pathologic (192 +/- 98 pg/mL) to normal values (39.93 +/- 25.12 pg/mL) during the third intraoperative determination (minute 15). Serum calcium level at 5 minutes after removal decreased by 100% in 34 patients, but iPTH only showed a similar drop during the third determination at 15 minutes. Frozen sections were conclusive for parathyroid tissue (20.56 +/- 10.3 minutes after removal).


CONCLUSIONS
Intraoperative measurement of total calcium level might be an easier and less expensive method than iPTH measurement in the prediction of cure during surgery for primary hyperparathyroidism resulting from adenoma.
Díaz-Aguirregoitia
Francisco Javier
FJ
Department of General Surgery, B Cruceś Hospital, Vizcaya, Spain.
Emparan
Carlos
C
Gaztambide
Sonia
S
Aniel-Quiroga
Maria Angeles
MA
Busturia
Maria Angeles
MA
Vázquez
José Antonio
JA
Pérdigo
Luis F
LF
Echenique-Elizondo
Miguel
M
D000236:Adenoma / Q000097:blood* / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D000368:Aged; D002118:Calcium / Q000097:blood*; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood* / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000097:blood* / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D016105:Parathyroidectomy / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016037:Single-Blind Method; D017256:Technetium Tc 99m Sestamibi; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
D010281:Parathyroid Hormone; D017256:Technetium Tc 99m Sestamibi; D002118:Calcium