title: Intra-operative parathyroid hormone monitoring through central laboratory is accurate in renal secondary hyperparathyroidism.
abstract: OBJECTIVE
  The usefulness, the methods and the criteria of intra-operative monitoring of the parathyroid hormone (ioPTH) during parathyroidectomy (PTX) for renal secondary hyperparathyroidism (rSHPT) in patients on chronic hemodialysis remain still matter of debate. The present study aimed to evaluate the ability of a low cost central-laboratory second generation PTH assay to predict an incomplete resection of parathyroid glands (PTG).
  
  
  METHODS
  The ioPTH decay was determined In 42 consecutive patients undergoing PTX (15 subtotal and 27 total without auto-transplant of PTG) for rSHPT. The ioPTH monitoring included five samples: pre-intubation, post-manipulation of PTG and at 10, 20 and 30min post-PTG excision. The patients with PTH exceeding the normal value (65pg/ml) at the first postoperative week, 6 and 12months were classified as persistent rSHPT.
  
  
  RESULTS
  The concentrations of ioPTH declined significantly over time in patients who received total or subtotal PTX; however, no difference was found between the two types of PTX. Irrespective of the type of PTX and the number of PTG removed, combining the absolute and percentage of ioPTH decay at 30min after PTG excision, we found high sensitivity (100%), specificity (92%), negative predictive value (100%) and accuracy (93%) in predicting the persistence of rSHPT.
  
  
  CONCLUSIONS
  The monitoring of the ioPTH decline by a low cost central-laboratory second generation assay is extremely accurate in predicting the persistence of disease in patients on maintenance hemodialysis undergoing surgery for rSHPT.
authors.affiliation: Division of General Surgery and Organ Transplantation, Catholic University of the Sacred Heart, Roma, Italy. Electronic address: c.vulpio@alice.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Vulpio
authors.affiliation: Division of General Surgery and Organ Transplantation, Catholic University of the Sacred Heart, Roma, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bossola
authors.affiliation: Institute of Biochemistry, Catholic University of the Sacred Heart, Roma, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Di Stasio
authors.affiliation: Division of General Surgery and Organ Transplantation, Catholic University of the Sacred Heart, Roma, Italy.
authors.forename: Gilda
authors.initials: G
authors.lastname: Pepe
authors.affiliation: Division of General Surgery and Organ Transplantation, Catholic University of the Sacred Heart, Roma, Italy.
authors.forename: Eda
authors.initials: E
authors.lastname: Nure
authors.affiliation: Division of General Surgery and Organ Transplantation, Catholic University of the Sacred Heart, Roma, Italy.
authors.forename: Sabina
authors.initials: S
authors.lastname: Magalini
authors.affiliation: Division of General Surgery and Organ Transplantation, Catholic University of the Sacred Heart, Roma, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Agnes
mesh_terms: D015415:Biomarkers / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood* / Q000209:etiology / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy / Q000009:adverse effects*; D011184:Postoperative Period; D011379:Prognosis; D006435:Renal Dialysis / Q000009:adverse effects*
chemical_list: D015415:Biomarkers; D010281:Parathyroid Hormone
keywords: Hemodialysis; Intra-operative parathyroid hormone; Parathyroid glands; Parathyroidectomy; Renal secondary hyperparathyroidism