title: Accuracy of intra-operative PTH measurement during subtotal parathyroidectomy for tertiary hyperparathyroidism after renal transplantation.
abstract: OBJECTIVE
  Intra-operative parathyroid hormone (IOPTH) results are not known in the setting of tertiary hyperparathyroidism (HPT) after renal transplantation.
  
  
  METHODS
  A retrospective analysis of 35 tertiary HPT patients who all underwent subtotal parathyroidectomy and IOPTH monitoring was conducted.
  
  
  RESULTS
  The mean follow-up time was 2.2+/-1.4 years. Thirty-four patients were cured; one patient (2.8%) had a persistent disease and was cured after reoperation. Median parathyroid hormone (PTH) (median percent decrease from highest) at baseline and at 5, 10, 20, and 30 min were 244, 78 (69%), 63 (75%), 53 (79%), and 49 pg/ml (83%), respectively. Four patients who were cured had a decrease of <50% at 5 min and two of them had a decrease of <50% at 10 min. The patient with persistent disease had a decrease of >50% at 10 min. The sensitivity of the test was 94% at 10 min using the Miami criteria.
  
  
  CONCLUSIONS
  This study shows that IOPTH in tertiary hyperparathyroidism has a high sensitivity. However, because of the low risk of persistent hyperparathyroidism when a subtotal parathyroidectomy is performed, its potential impact on the overall success rate is very small. We therefore do not recommend the routine use of IOPTH in tertiary hyperparathyroidism.
authors.affiliation: General and Endocrine Surgery, University Hospital of Lille, 59037 Lille, France. frederic.triponez@hcuge.ch
authors.forename: Frederic
authors.initials: F
authors.lastname: Triponez
authors.forename: David
authors.initials: D
authors.lastname: Dosseh
authors.forename: Marc
authors.initials: M
authors.lastname: Hazzan
authors.forename: Christian
authors.initials: C
authors.lastname: Noel
authors.forename: Benoit
authors.initials: B
authors.lastname: Soudan
authors.forename: Jonathan
authors.initials: J
authors.lastname: Lokey
authors.forename: Martha
authors.initials: M
authors.lastname: Mozzon
authors.forename: Charles A G
authors.initials: CA
authors.lastname: Proye
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood* / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000601:surgery; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy; D015203:Reproducibility of Results; D012189:Retrospective Studies
chemical_list: D010281:Parathyroid Hormone