[Intraoperative parathyroid hormone measurement in patients with primary hyperparathyroidism; particularly valuable for suspected solitary parathyroid adenoma and re-operation].
OBJECTIVE
Analysis of the value of intraoperative parathormone (PTH) measurement in patients with primary hyperparathyroidism.


METHODS
Prospective study.


METHODS
Evaluation of the value of intraoperative measurement ofPTH in 75 patients (including 19 patients with multiple endocrine neoplasia(MEN)-1 syndrome) who underwent parathyroidectomy in 2001-2005.


RESULTS
The so-called Miami-criterion (PTH concentration 10 min after excision at least 50% below the value measured prior to the first incision) correctly predicted the success of the operation in 91% of the subjects. The success rate was correctly predicted as follows: in subgroups of patients with MEN-1 syndrome, 85%, patients after exclusion of MEN-1, 94%, and patients in whom a solitary adenoma was likely after preoperative localization studies, 97%. In 13% of the total number of operations, PTH-measurements led to further exploration, removal of additional parathyroid tissue and normocalcemia postoperatively. In patients without MEN-1 syndrome, in whom a solitary adenoma was likely on the basis of preoperative investigations, it was possible to limit the operation to a unilateral procedure in 87%.


CONCLUSIONS
In the majority of patients with primary hyperparathyroidism, intraoperative PTH-measurement in combination with preoperative imaging studies leads to patients being cured with a unilateral instead of a bilateral operation.
Freriks
K
K
Afd. Endocriene Ziekten, Universitair Medisch Centrum St Radboud, Postbus 9101, 6500 HB Nijmegen.
den Heijer
M
M
Bonenkamp
J J
JJ
Biert
J
J
Sweep
C G J
CG
Hermus
A R M M
AR
D000236:Adenoma / Q000601:surgery*; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D010281:Parathyroid Hormone / Q000097:blood*; D010282:Parathyroid Neoplasms / Q000601:surgery*; D016105:Parathyroidectomy; D016896:Treatment Outcome
D010281:Parathyroid Hormone