Intraoperative parathyroid hormone assay in patients with primary hyperparathyroidism and double adenoma

Emad Kandil, Haytham H. Alabbas, Anshuman Bansal, Tareq Islam, Anthony P. Tufaro, Ralph P Tufano

Research output: Contribution to journalArticle

Abstract

Objective: To determine the utility of parathyroid hormone (PTH) monitoring for double adenomas (DAs). Design: Retrospective chart review. Setting: Tertiary referral center. Patients: The study included 47 patients with primary hyperparathyroidism who had DAs identified during firsttime parathyroid exploration. Main Outcome Measures: Intraoperative PTH levels were measured in every case, and the intraoperative PTH assay and its influence on surgical outcome were examined. Results: A total of 47 of 552 consecutive patients (8.5%) with primary hyperparathyroidism were found to have DAs; 457 patients (82.7%) had single adenomas; and 48 patients (8.6%) had disease in more than 2 glands. The mean (SD) age of the patients with DAs was 58 (14) years, and 26 patients (55%) were female. The mean (SD) preoperative intact PTH level was 129 (57) pg/mL (to convert to nanograms per liter, multiply by 1), and the preoperative serum calcium level was 11.0 (0.6) mg/dL (to convert to millimoles per liter, multiply by 0.25). In all patients, the intraoperative PTH levels decreased by 79.7% (11.4%) from baseline after removal of both abnormal parathyroid glands. When the location could be confirmed, the second adenoma was ipsilateral in 17 patients (36%) and contralateral in 27 patients (64%). The mean (SD) postoperative intact PTH level was 46 (26) pg/mL at 6 months, and the cure rate was 98%. Conclusions: Intraoperative PTH monitoring and maintenance of normocalcemia after surgery confirm previous reports that DAs do exist and are not simply missed cases of 4-gland hyperplasia. Intraoperative PTH monitoring accurately predicted the success of parathyroidectomy in 98% of patients with DAs.

Original languageEnglish (US)
Pages (from-to)1206-1208
Number of pages3
JournalArchives of Otolaryngology--Head and Neck Surgery
Volume135
Issue number12
DOIs
StatePublished - Dec 2009

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Primary Hyperparathyroidism
Parathyroid Hormone
Adenoma
Parathyroidectomy
Parathyroid Glands
Tertiary Care Centers
Hyperplasia
Maintenance
Outcome Assessment (Health Care)
Calcium

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Surgery

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Intraoperative parathyroid hormone assay in patients with primary hyperparathyroidism and double adenoma. / Kandil, Emad; Alabbas, Haytham H.; Bansal, Anshuman; Islam, Tareq; Tufaro, Anthony P.; Tufano, Ralph P.

In: Archives of Otolaryngology--Head and Neck Surgery, Vol. 135, No. 12, 12.2009, p. 1206-1208.

Research output: Contribution to journalArticle

Kandil, Emad ; Alabbas, Haytham H. ; Bansal, Anshuman ; Islam, Tareq ; Tufaro, Anthony P. ; Tufano, Ralph P. / Intraoperative parathyroid hormone assay in patients with primary hyperparathyroidism and double adenoma. In: Archives of Otolaryngology--Head and Neck Surgery. 2009 ; Vol. 135, No. 12. pp. 1206-1208.
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abstract = "Objective: To determine the utility of parathyroid hormone (PTH) monitoring for double adenomas (DAs). Design: Retrospective chart review. Setting: Tertiary referral center. Patients: The study included 47 patients with primary hyperparathyroidism who had DAs identified during firsttime parathyroid exploration. Main Outcome Measures: Intraoperative PTH levels were measured in every case, and the intraoperative PTH assay and its influence on surgical outcome were examined. Results: A total of 47 of 552 consecutive patients (8.5{\%}) with primary hyperparathyroidism were found to have DAs; 457 patients (82.7{\%}) had single adenomas; and 48 patients (8.6{\%}) had disease in more than 2 glands. The mean (SD) age of the patients with DAs was 58 (14) years, and 26 patients (55{\%}) were female. The mean (SD) preoperative intact PTH level was 129 (57) pg/mL (to convert to nanograms per liter, multiply by 1), and the preoperative serum calcium level was 11.0 (0.6) mg/dL (to convert to millimoles per liter, multiply by 0.25). In all patients, the intraoperative PTH levels decreased by 79.7{\%} (11.4{\%}) from baseline after removal of both abnormal parathyroid glands. When the location could be confirmed, the second adenoma was ipsilateral in 17 patients (36{\%}) and contralateral in 27 patients (64{\%}). The mean (SD) postoperative intact PTH level was 46 (26) pg/mL at 6 months, and the cure rate was 98{\%}. Conclusions: Intraoperative PTH monitoring and maintenance of normocalcemia after surgery confirm previous reports that DAs do exist and are not simply missed cases of 4-gland hyperplasia. Intraoperative PTH monitoring accurately predicted the success of parathyroidectomy in 98{\%} of patients with DAs.",
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AU - Tufaro, Anthony P.

AU - Tufano, Ralph P

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AB - Objective: To determine the utility of parathyroid hormone (PTH) monitoring for double adenomas (DAs). Design: Retrospective chart review. Setting: Tertiary referral center. Patients: The study included 47 patients with primary hyperparathyroidism who had DAs identified during firsttime parathyroid exploration. Main Outcome Measures: Intraoperative PTH levels were measured in every case, and the intraoperative PTH assay and its influence on surgical outcome were examined. Results: A total of 47 of 552 consecutive patients (8.5%) with primary hyperparathyroidism were found to have DAs; 457 patients (82.7%) had single adenomas; and 48 patients (8.6%) had disease in more than 2 glands. The mean (SD) age of the patients with DAs was 58 (14) years, and 26 patients (55%) were female. The mean (SD) preoperative intact PTH level was 129 (57) pg/mL (to convert to nanograms per liter, multiply by 1), and the preoperative serum calcium level was 11.0 (0.6) mg/dL (to convert to millimoles per liter, multiply by 0.25). In all patients, the intraoperative PTH levels decreased by 79.7% (11.4%) from baseline after removal of both abnormal parathyroid glands. When the location could be confirmed, the second adenoma was ipsilateral in 17 patients (36%) and contralateral in 27 patients (64%). The mean (SD) postoperative intact PTH level was 46 (26) pg/mL at 6 months, and the cure rate was 98%. Conclusions: Intraoperative PTH monitoring and maintenance of normocalcemia after surgery confirm previous reports that DAs do exist and are not simply missed cases of 4-gland hyperplasia. Intraoperative PTH monitoring accurately predicted the success of parathyroidectomy in 98% of patients with DAs.

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