Quick PTH assay cannot predict incomplete parathyroidectomy in patients with renal hyperparathyroidism.
BACKGROUND
Contradictory reports on the value of intraoperative quick parathyroid hormone (PTH) monitoring in renal hyperparathyroidism have been published.


METHODS
Thirty-five consecutive patients underwent total parathyroidectomy, central neck dissection, bilateral thymectomy, and immediate autotransplantation. PTH levels were measured by PTH assay at induction of anesthesia (baseline level) and in 5-minute intervals after excision of the last parathyroid gland. Parathyroidectomy was considered "total" in patients with PTH levels <10 pg/mL (subgroup 1), "subtotal" between 10 and 65 pg/mL (subgroup 2) and "insufficient" at >65 pg/mL (subgroup 3) within the first postoperative week.


RESULTS
Fifteen minutes after excision of the last gland, PTH levels dropped to 19.4 +/- 15.7% (subgroup 1), 14.9 +/- 5.9% (subgroup 2), and 18 +/- 6.7% (subgroup 3) from baseline among 22 patients on hemodialysis, to 22.1 +/- 18.7% and 17.5% in 9 patients (subgroups 1 and 2) after successful kidney transplantation, and to 10.7% and 17.5% (subgroup 1) and 12.8% and 31.4% (subgroup 2) in 4 patients with reduced renal function after kidney transplantation.


CONCLUSIONS
Currently available QPTH assays are not useful to predict insufficient resection of hyperfunctioning parathyroid tissue.
Kaczirek
Klaus
K
Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria. Klaus.kaczirek@meduniwien.ac.at
Riss
Philipp
P
Wunderer
Gerald
G
Prager
Gerhard
G
Asari
Reza
R
Scheuba
Christian
C
Bieglmayer
Christian
C
Niederle
Bruno
B
D005500:Follow-Up Studies; D006801:Humans; D006961:Hyperparathyroidism / Q000209:etiology / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D016030:Kidney Transplantation / Q000009:adverse effects / Q000502:physiology; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy / Q000379:methods; D011237:Predictive Value of Tests; D006435:Renal Dialysis; D013997:Time Factors
D010281:Parathyroid Hormone