Significance of biochemical parameters in differentiating uniglandular from multiglandular disease and limiting use of intraoperative parathormone assay.
BACKGROUND
We studied whether serum calcium and parathormone (PTH) levels are significantly different for uniglandular disease (UGD) and multiglandular disease (MGD) and whether intraoperative rapid intact parathormone (IOPTH) monitoring can be avoided in some cases of minimally invasive parathyroidectomy (MIP) without affecting cure rates, substantiating various previous published studies.


METHODS
This is a single-referral-center retrospective review of prospectively collected data for 281 patients with sporadic primary hyperparathyroidism (sPHPT) from January 1999 to February 2005. The calcium and PTH values were categorized using the following parameters: calcium > or = 3 mmol/l = 1, < 3 mmol/l = 0, PTH > or = 100 pg/ml = 1, PTH < 100 = 1.


RESULTS
P values for serum calcium and PTH by ANOVA were 0.0547 and 0.3936, respectively, and by the Mann-Whitney test were 0.1606 and 0.6208, respectively. We had 118 patients with concordant technetium 99 m sestamibi scintigraphy (MIBI) and neck ultrasonography (US) and UGD was confirmed in 118 (100%) cases.


CONCLUSIONS
No significant difference between serum calcium and PTH for UGD and MGD was found. IOPTH monitoring could be avoided when there is concordant positive MIBI and neck US for single, unilateral, hyperfunctioning gland without affecting cure rates.
Department of Endocrine Surgery, University Hospital La Timone, 264, Rue Saint-Pierre, 13385, Marseille, France.
Abhijit
A
Thakur
Frederic
F
Sebag
Eveline
E
Slotema
Giuseppe
G
Ippolito
David
D
Taïeb
Jean François
JF
Henry
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000097:blood*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009333:Neck / Q000000981:diagnostic imaging; D009378:Neoplasms, Multiple Primary / Q000097:blood* / Q000000981:diagnostic imaging; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy / Q000379:methods; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult
D015415:Biomarkers; D010281:Parathyroid Hormone; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D002118:Calcium