Abstract
Background
This study aims to determine whether intraoperative parathyroid hormone monitoring
helps to predict early surgical outcomes in patients with renal hyperparathyroidism
and evaluate the impact on decision making during surgery.
Methods
A prospective study was conducted. Serial samples of the intraoperative parathyroid
hormone were collected; 2 of these were taken before the excision, and 2 were taken
after the planned parathyroid resection (10 minutes and 15 minutes). We tested the
criterion of an intraoperative parathyroid hormone percentage decay ≥80% of the highest
value of the basal samples as a predictor of success.
Results
Of the 228 patients, parathyroidectomy achieved success in 92.1%. In patients with
secondary hyperparathyroidism, the failure group showed a tendency to stabilize or
even increase the intraoperative parathyroid hormone values from the 10-minute measure
(577 pg/mL) to the 15-minute measure (535 pg/mL) (P = .903). Conversely, intraoperative parathyroid hormone continued to drop in those
with a successful outcome: 245 pg/mL (10 minutes) and 206 pg/mL (15 minutes) (P < .001). The failure group had a significantly lower percentage decay (P < .001) from baseline when compared with the success group. The intraoperative parathyroid
hormone influenced the surgical management in up to 7% of the cases. The intraoperative
parathyroid hormone dosage method showed an accuracy of 86%, a sensitivity of 88%,
and specificity of 67%.
Conclusion
In patients with renal hyperparathyroidism undergoing parathyroidectomy, the use of
intraoperative parathyroid hormone may help to predict an early therapeutic outcome
with high sensitivity and accuracy by indicating the operation's success when there
is an 80% reduction of baseline intraoperative parathyroid hormone 15 minutes after
removal of the enlarged glands, an associated continuous decrease in serum intraoperative
parathyroid hormone levels between 10 and 15 minutes, and achievement of plasma target
values <500 pg/mL.
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Article info
Publication history
Published online: August 15, 2020
Accepted:
June 30,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
