Effectiveness of parathyroid-hormone measurement in detecting patients with multiple gland disease causing primary hyperparathyroidism.
OBJECTIVE
Intraoperative parathyroid hormone measurement (iPTH) has strengthened the successful use of minimal-invasive approaches in surgery of primary hyperparathyroidism (pHPT). The aim of the study was to evaluate the efficacy of iPTH monitoring in treating pHPT resulting from multiple gland disease.


METHODS
In this retrospective study, 58 patients with pHPT underwent surgery (minimally invasive or open exploration) between January 2003 and July 2005. iPTH levels were routinely measured at the start of anesthesia, in any case before skin incision, and 10 as well as 15 min after removal of abnormal gland(s). A drop in iPTH >50% after 10 min and >60% after 15 min was considered adequate to prove the success of the removal of the abnormal gland(s). The removed tissue was examined histologically by immediate frozen section.


RESULTS
A single gland disease was found in 51 (88%) cases, a multiple gland disease (double adenoma or hyperplasia) in 7 (12%) cases. In all cases of single adenoma, an adequate drop of iPTH was seen after removal of the pathologic gland. In contrast, in all cases with a second adenoma, an adequate drop in iPTH was detected only after removal of both adenoma/hyperplasia. Immediate sectioning was only helpful for identification of removed tissue, but was no help in deciding whether to search for an additional gland. The follow-up showed no late disease recurrence.


CONCLUSIONS
The measurement of iPTH is an effective and safe means in treating single gland disease as well as multiple gland disease (adenoma/hyperplasia) causing pHPT and also allows a successful limited dissection via minimally invasive parathyroidectomy.
Agha
Ayman
A
Department of Surgery, University Hospital of Regensburg, Franz-Josef-Strauss Allee 11, 93053 Regensburg, Germany. ayman.agha@klinik.uni-regensburg.de
Scherer
Marcus Nils
MN
Mantouvalou
Kiriaki
K
Woenckhaus
Matthias
M
Froehlich
Dieter
D
Barlage
Stefan
S
Dada
Ashraf
A
Schlitt
Hans Jürgen
HJ
D002118:Calcium / Q000097:blood; D003952:Diagnostic Imaging; D005500:Follow-Up Studies; D005629:Frozen Sections; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood* / Q000175:diagnosis / Q000601:surgery*; D006965:Hyperplasia / Q000097:blood / Q000473:pathology / Q000601:surgery; D019060:Minimally Invasive Surgical Procedures; D009378:Neoplasms, Multiple Primary / Q000097:blood* / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D010280:Parathyroid Glands / Q000473:pathology*; D010281:Parathyroid Hormone / Q000097:blood*; D010282:Parathyroid Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000601:surgery*; D016105:Parathyroidectomy; D011183:Postoperative Complications / Q000097:blood; D011237:Predictive Value of Tests
D010281:Parathyroid Hormone; D002118:Calcium