The impact of vitamin D status and tumor size on the intraoperative parathyroid hormone dynamics in patients with symptomatic primary hyperparathyroidism.
OBJECTIVE
The intraoperative parathyroid hormone (IOPTH) monitoring is a useful adjunct for predicting whether a cure has been obtained during parathyroidectomy. We studied the influence of vitamin D status and parathyroid tumor weight on the IOPTH dynamics for predicting a cure in patients with symptomatic primary hyperparathyroidism.


METHODS
Fifty-nine primary hyperparathyroidism patients with a single adenoma underwent curative surgery. Patients were grouped according to their serum 25-hydroxy vitamin D levels (deficient, insufficient and sufficient) and tumor weights (small, large and giant). The IOPTH results in patient groups were compared, and the percentage of the IOPTH decrease was examined for a correlation with the serum 25-hydroxy vitamin D level and tumor weight.


RESULTS
The sensitivity, specificity and overall accuracy of IOPTH in predicting a cure of hyperparathyroidism were 94.8, 100 and 93.2%, respectively. The percentage decrease in the IOTPH was significantly higher in the vitamin D deficient, compared to the vitamin D sufficient patients (p = 0.012); and in the patients with larger tumors, compared to those with smaller parathyroid tumors (p = 0.02). A statistically significant correlation was found between the percentage decrease in the IOPTH at 10 min post-tumor excision and the serum 25-hydroxy vitamin D level (p = 0.037), but not with the tumor weight (p = 0.208).


CONCLUSIONS
The IOPTH can accurately predict a cure in patients with severe primary hyperparathyroidism. The percentage of decrease in the IOPTH is steeper in patients with lower serum 25-hydroxy vitamin D levels and larger parathyroid tumors.
The Department of Endocrine, Endocrine Sciences Centre, SGPGIMS, Raebareli Road, Lucknow 226014, India. gaurav@sgpgi.ac.in
Gaurav
G
Agarwal
Dhalapathy
D
Sadacharan
Pooja
P
Ramakant
Manoj
M
Shukla
Saroj K
SK
Mishra
D000236:Adenoma / Q000097:blood* / Q000150:complications / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000150:complications; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000097:blood* / Q000150:complications / Q000473:pathology* / Q000601:surgery; D016105:Parathyroidectomy; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D047368:Tumor Burden; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D055815:Young Adult
D014408:Biomarkers, Tumor; D010281:Parathyroid Hormone; D014807:Vitamin D; C104450:25-hydroxyvitamin D