PTH spikes during parathyroid exploration--a possible pitfall during PTH monitoring?
OBJECTIVE
Parathyroid hormone (PTH) spikes caused by unintentional manipulation of the hypersecreting glands may lead to interpretation problems in intraoperative PTH monitoring. Their frequency and surgical consequences were evaluated.


METHODS
Intraoperative PTH values of 401 patients with primary hyperparathyroidism and single gland disease were analysed. Patients were divided into four groups: extensive increase (>150 pg/ml), moderate PTH increase (<150 pg/ml), no increase (+/-50 pg/ml) and decrease before excision as referred to the baseline level before skin incision. PTH was measured before and up to 25 min after removal of the enlarged gland.


RESULTS
Twenty-two (5.5%) patients had an extensive and 36 (9%) a moderate intraoperative PTH increase. The PTH decline was prolonged to 15 min in 7 (31.8%) and to 25 min in 12 (54.5%) patients after extensive manipulation and in 9 patients (25%) each after moderate manipulation, respectively. No increase occurred in 162 (40.4%) and a decrease in 181 (45.1%) patients. The surgical approach (bilateral exploration vs open, minimally invasive parathyroidectomy) did not show a difference in the rate of PTH spikes.


CONCLUSIONS
PTH spikes often cause a prolonged PTH decline but, when recognized, do not lead to a change in the surgical strategy.
Riss
Philipp
P
Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
Kaczirek
Klaus
K
Bieglmayer
Christian
C
Niederle
Bruno
B
D003404:Creatinine / Q000097:blood; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood* / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures; D016343:Monitoring, Intraoperative; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy / Q000379:methods
D010281:Parathyroid Hormone; D003404:Creatinine