Recent findings in the use of intraoperative parathyroid hormone monitoring in parathyroid disease.
OBJECTIVE
To discuss recent findings and controversies regarding intraoperative parathyroid hormone monitoring (IPM) in guiding parathyroidectomy.


RESULTS
IPM is being frequently used in guiding surgeons to complete excision of abnormal glands during parathyroidectomy for sporadic primary hyperparathyroidism (SPHPT). This adjunct is now being used in many centers around the world and has become a standard of care in the treatment of SPHPT. As the use of this technique developed, the understanding of what was necessary to return patients with hyperparathyroidism to a eucalcemic state, namely, excision of all parathyroid tissue secreting high amount of parathyroid hormone, was recognized. Two major controversies have developed during the evolution of IPM guided parathyroidectomy. One is that gland excision based on this modality may not recognize all abnormal glands, which, if not excised, will result in operative failure or recurrent hyperparathyroidism. The second disagreement is a technical one and concerns the best intraoperative protocol to be used.


CONCLUSIONS
Parathyroidectomy for SPHPT is highly successful regardless of the operative approach used. Despite the controversies summarized in the present review, IPM has been shown to be accurate as an adjunct to guide parathyroidectomy and has changed the operative management of SPHPT.
Carneiro-Pla
Denise
D
Medical University of South Carolina, Department of Surgery, Charleston, South Carolina, USA. carneiro@musc.edu
D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000601:surgery*; D016343:Monitoring, Intraoperative / Q000379:methods*; D010281:Parathyroid Hormone / Q000032:analysis* / Q000378:metabolism; D016105:Parathyroidectomy / Q000379:methods*
D010281:Parathyroid Hormone