Abstract
Background
Intraoperative parathyroid hormones have been used to establish operative success
in patients with primary hyperparathyroidism. This study’s aim was to assess the impact
of estimated glomerular filtration rate and serum creatinine levels on the fulfillment
of >50% drop and normalization of intraoperative parathyroid hormone levels.
Methods
Patients successfully treated for primary hyperparathyroidism were analyzed. The samples
for parathyroid hormone were collected at baseline, 5-, 10-, and 30-minutes postexcision.
The patients were classified as follows: (1) estimated glomerular filtration rate
>60 mL/min, (2) estimated glomerular filtration rate <60 mL/min and serum creatinine
levels <1.2 mg/dL, and (3) estimated glomerular filtration rate <60 mL/min and serum
creatinine levels >1.2 mg/dL. Comparative analysis of patients achieving the >50%
parathyroid hormone drop criterion and normalization of intraoperative parathyroid
hormone was performed.
Results
One hundred-fourteen patients were distributed as follows: 88 patients (77.2%), 14
(12.3%), and 12 (10.5%) for groups 1, 2 and 3, respectively. No difference between
groups in the proportion of patients fulfilling the >50% parathyroid hormone drop
criterion was found. An abnormally elevated intraoperative parathyroid hormone level
at 30-minute postexcision was observed in 0, 14.3, and 16.6% in groups 1, 2, and 3,
respectively (P ≤ .0001).
Conclusion
In the study, >50% parathyroid hormone drop criterion was equally achieved despite
normal or reduced estimated glomerular filtration rate. When serum creatinine levels
increased >1.2 mg/dL and estimated glomerular filtration rate declined <60 mL/min,
the likelihood of reaching normal intraoperative parathyroid hormone levels postexcision
was significantly lower.
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Article info
Publication history
Published online: October 11, 2022
Accepted:
July 11,
2022
Footnotes
This paper has been accepted for a podium presentation at the 42nd Annual Meeting of the American Association of Endocrine Surgeons to be held in Cleveland, OH, May 22–24, 2022.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
