Abstract
Background. The utility of intraoperative parathyroid hormone (PTH) monitoring is unclear in
the surgical management of renal hyperparathyroidism. Our goal was to define the normal
pattern of decay during operation for renal hyperparathyroidism by using the rapid
intact (1-84) parathyroid hormone (PTH) assay. Methods. Eighty consecutive patients underwent neck exploration for renal hyperparathyroidism.
Intact PTH levels were monitored with a rapid immunochemiluminometric assay. Samples
were assayed at the induction of anesthesia, after dissection before resection, and
20 and 40 minutes after resection. Follow-up ranged from 3 to 24 months. Results. Twenty minutes after resection, PTH levels remained many-fold supranormal. Seventy-seven
patients (96%) were cured. Of these, 75 patients (94%) had PTH decay of more than
50% from the preoperative level; 74 (99%) were cured. Only 1 of 3 patients (33%) in
whom the PTH level decreased less than 40% from the preoperative level was cured.
Two patients had intermediate values and both were cured. Conclusions. The intraoperative decay of PTH during operation for renal hyperparathyroidism is
slower than for patients with normal renal function. However, 20 minutes after resection,
a decline to less than 50% of the preoperative level predicts cure, while a level
greater than 60% predicts failure. (Surgery 2000;128:1029-34.)
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Article info
Footnotes
*Reprint requests: Charles A. G. Proye, Service de Chirurgie Generale et Endocrinienne, Hôpital Claude Huriez, F59037 Lille, France.
**Surgery 2000;128:1029-34.
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
