Interpretation of intra-operative PTH changes in patients with multi-glandular primary hyperparathyroidism (pHPT)

Giorgos Constantine Karakousis, Dale Han, Rachel Rapaport Kelz, Deepika Nemani, Jagajan Karamacharya, Robert Roses, Phyllis A. Gimotty, Douglas L. Fraker

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Background: The correct interpretation of intraoperative parathyroid hormone (IOPTH) levels in patients with primary hyperparathyroid patients (pHPT) with multiglandular disease (MGD) can impact the success rate of initial parathyroid exploration, but it remains an understudied topic. Methods: In all, 592 of 823 patients were explored by a single surgeon with biochemical evidence of pHPT (1997-2007) and underwent parathyroidectomy using IOPTH. We investigated the incidence of MGD in patients with an appreciable (>50%) decrease in IOPTH levels and in patients whose levels failed to normalize after single gland excision. Results: The mean age of patients was 56.7 years, and 74% of patients were women. Thirty-one patients had PTH levels that decreased by greater than 50% from baseline 10-15 min after single gland excision, but the levels failed to normalize. Of these, 9 patients (29%) had MGD (8 double adenomas, 1 hyperplasia). The incidence of MGD in the remainder of IOPTH patients was 13.9% (78 of 561 patients). Within the subgroup of 31 patients, those with single adenomas did not differ from patients with MGD in baseline IOPTH levels and weights of first adenoma excised, although they demonstrated greater serum creatinine concentrations and a decrease in mean IOPTH. Conclusion: Commonly accepted decreases in IOPTH levels (>50%) for patients who undergo minimally invasive parathyroidectomy may lead to an appreciable number of missed parathyroid adenomas or hyperplastic disease.

Original languageEnglish (US)
Pages (from-to)845-850.e2
JournalSurgery
Volume142
Issue number6
DOIs
StatePublished - Jan 1 2007
Externally publishedYes

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Primary Hyperparathyroidism
Parathyroid Hormone
Adenoma
Parathyroidectomy
Parathyroid Neoplasms
Incidence
Hyperplasia
Creatinine

ASJC Scopus subject areas

  • Surgery

Cite this

Karakousis, G. C., Han, D., Kelz, R. R., Nemani, D., Karamacharya, J., Roses, R., ... Fraker, D. L. (2007). Interpretation of intra-operative PTH changes in patients with multi-glandular primary hyperparathyroidism (pHPT). Surgery, 142(6), 845-850.e2. https://doi.org/10.1016/j.surg.2007.09.009

Interpretation of intra-operative PTH changes in patients with multi-glandular primary hyperparathyroidism (pHPT). / Karakousis, Giorgos Constantine; Han, Dale; Kelz, Rachel Rapaport; Nemani, Deepika; Karamacharya, Jagajan; Roses, Robert; Gimotty, Phyllis A.; Fraker, Douglas L.

In: Surgery, Vol. 142, No. 6, 01.01.2007, p. 845-850.e2.

Research output: Contribution to journalArticle

Karakousis, GC, Han, D, Kelz, RR, Nemani, D, Karamacharya, J, Roses, R, Gimotty, PA & Fraker, DL 2007, 'Interpretation of intra-operative PTH changes in patients with multi-glandular primary hyperparathyroidism (pHPT)', Surgery, vol. 142, no. 6, pp. 845-850.e2. https://doi.org/10.1016/j.surg.2007.09.009
Karakousis, Giorgos Constantine ; Han, Dale ; Kelz, Rachel Rapaport ; Nemani, Deepika ; Karamacharya, Jagajan ; Roses, Robert ; Gimotty, Phyllis A. ; Fraker, Douglas L. / Interpretation of intra-operative PTH changes in patients with multi-glandular primary hyperparathyroidism (pHPT). In: Surgery. 2007 ; Vol. 142, No. 6. pp. 845-850.e2.
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