title: Is intraoperative parathyroid hormone monitoring necessary for primary hyperparathyroidism with concordant preoperative imaging?
abstract: BACKGROUND
  The purpose of this study was to determine if intraoperative parathyroid hormone (PTH) monitoring is necessary in patients with concordant ultrasound and sestamibi imaging.
  
  
  METHODS
  Clinical factors, intraoperative findings and outcome were correlated with imaging results in patients with primary hyperparathyroidism who underwent parathyroidectomy with concordant ultrasound and sestamibi imaging.
  
  
  RESULTS
  There were 127 patients with primary hyperparathyroidism and concordant imaging who underwent parathyroidectomy. Seven patients (5.5%) had intraoperative findings that were discordant with imaging: 2 (1.6%) had an adenoma at a different location, 2 (1.6%) had double adenomas and 3 (2.4%) had asymmetric hyperplasia. Gland weight and preoperative PTH levels were greater for patients with concordant operative and imaging findings (p < 0.05).
  
  
  CONCLUSIONS
  Six percent of patients with concordant ultrasound and sestamibi imaging had unexpected intraoperative findings. Intraoperative PTH monitoring remains a necessary adjunct even with concordant imaging to ensure identification of abnormal parathyroid glands and cure of hyperparathyroidism.
authors.affiliation: Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors.forename: Iuliana D
authors.initials: ID
authors.lastname: Bobanga
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Surgery, MetroHealth Medical Center, Cleveland, OH, USA. Electronic address: cmchenry@metrohealth.org.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: McHenry
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000209:etiology / Q000601:surgery*; D006965:Hyperplasia / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010280:Parathyroid Glands / Q000000981:diagnostic imaging / Q000473:pathology; D010281:Parathyroid Hormone / Q000097:blood*; D010282:Parathyroid Neoplasms / Q000473:pathology / Q000601:surgery; D016105:Parathyroidectomy; D011300:Preoperative Care; D012189:Retrospective Studies
chemical_list: D010281:Parathyroid Hormone
keywords: Focused parathyroidectomy; Hyperparathyroidism; Intraoperative PTH; Minimally invasive parathyroidectomy