title: Intraoperative parathyroid hormone monitoring corroborates the success of parathyroidectomy in children.
abstract: OBJECTIVE
  To assess the efficacy of intraoperative parathyroid hormone (PTH) monitoring in evaluating the outcome of parathyroidectomy in pediatric patients.
  
  
  METHODS
  Intraoperative PTH monitoring during parathyroidectomy was performed in five children (3M, 2F); three had parathyroid adenomas (single gland disease) and two had primary hyperplasia. One patient had undergone two previous surgical interventions to remove the parathyroid glands, but the PTH levels had remained high with persistence of symptoms. Immunoradiometric analysis was used for PTH measurements. Preoperative PTH values were obtained to monitor the baseline levels. Serum samples were collected 20 minutes after removal of the adenoma/parathyroid gland(s) and PTH levels were compared with preoperative values. Specimens were also confirmed by frozen sectional examination.
  
  
  RESULTS
  Mean age of the patients was 11 years (range: 3 months-16 years). Mean preoperative PTH values were 633.3±579 pg/mL (range: 143-1300 pg/mL). Intraoperative values decreased to 18.7±5.5 pg/mL (range: 8-27 pg/mL) following removal of the gland(s). Normal calcium levels were achieved with adequate management following surgery. One patient (with multiple surgeries and found to have an ectopic parathyroid gland) had hungry bone syndrome after the operation and was treated successfully. There were no major complications. All patients maintained normal calcium/phosphorus levels in the follow-up period, ranging from 2 to 5 years.
  
  
  CONCLUSIONS
  An ectopic parathyroid gland or another undetected adenoma can be overlooked during surgery. Owing to the short life of the hormone, intraoperative PTH monitoring to determine PTH clearance proved to be a feasible marker for adequacy and safety of surgery and "cure".
authors.affiliation: University Faculty of Medicine, Department of Pediatric Surgery, İzmir, Turkey. E-ma-il: ahmet.celik@ege.edu.tr.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Çelik
authors.forename: Emre
authors.initials: E
authors.lastname: Divarcı
authors.forename: Zafer
authors.initials: Z
authors.lastname: Dökümcü
authors.forename: Orkan
authors.initials: O
authors.lastname: Ergün
authors.forename: Samim
authors.initials: S
authors.lastname: Özen
authors.forename: Damla
authors.initials: D
authors.lastname: Gökşen
authors.forename: Şükran
authors.initials: Ş
authors.lastname: Darcan
authors.forename: Yeşim
authors.initials: Y
authors.lastname: Ertan
mesh_terms: D000236:Adenoma / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D002648:Child; D005260:Female; D005629:Frozen Sections; D006801:Humans; D006965:Hyperplasia; D007223:Infant; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D010279:Parathyroid Diseases / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D010281:Parathyroid Hormone / Q000097:blood*; D010282:Parathyroid Neoplasms / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D016105:Parathyroidectomy / Q000009:adverse effects; D011237:Predictive Value of Tests; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; C470125:PTH protein, human; D010281:Parathyroid Hormone