title: Rapid intraoperative immunoassay of parathyroid hormone and other hormones: a new paradigm for point-of-care testing.
abstract: BACKGROUND
  The first description of the use of a rapid assay for the measurement of intact parathyroid hormone (PTH) in patients undergoing parathyroidectomy for hyperparathyroidism was reported in 1988. Subsequent improvements in the analytical performance of the rapid intraoperative PTH assay allowed the establishment of its clinical utility in the surgical management of hyperparathyroidism. These modifications also allowed the assay to be performed in or near the operating suite.
  
  
  METHODS
  We searched MEDLINE, using the following key words: intraoperative, rapid, quick, parathyroid hormone, hormone, and immunoassay. Relevant articles that focused on the analytical aspects and clinical utility of rapid intraoperative hormone immunoassays were selected for this review.
  
  
  BACKGROUND
  On the basis of the positive impact that the rapid intraoperative PTH test has had on both patient outcomes and cost savings, other rapid intraoperative hormone immunoassays for the diagnosis and/or treatment of other endocrine-hormone-secreting tumors have been developed. These hormones share certain characteristics that make them suitable for use as rapid intraoperative tests, i.e., short analyte half-life and/or large analyte concentration gradient, rapid analysis time, and positive clinical utility. Initial studies with cortisol, gastrin, insulin, adrenocorticotropic hormone, and testosterone have shown promising results in preoperative localization studies and/or for assessing the effectiveness of tumor resection during surgery.
  
  
  CONCLUSIONS
  The emergence of these rapid intraoperative immunoassays indicates that this test format is likely to provide future opportunities to improve patient care by advances in clinical laboratory testing.
authors.affiliation: Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Sokoll
authors.forename: Frank H
authors.initials: FH
authors.lastname: Wians
authors.forename: Alan T
authors.initials: AT
authors.lastname: Remaley
mesh_terms: D019411:Clinical Laboratory Techniques; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006961:Hyperparathyroidism / Q000175:diagnosis* / Q000601:surgery*; D007118:Immunoassay / Q000379:methods; D007432:Intraoperative Period; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy; D036361:Peptide Hormones / Q000097:blood; D019095:Point-of-Care Systems; D013739:Testosterone / Q000097:blood
chemical_list: D010281:Parathyroid Hormone; D036361:Peptide Hormones; D013739:Testosterone; D006854:Hydrocortisone