Peroperative measurement of PTH in the management of primary hyperparathyroidism

Abstract

This study was performed to prospectively evaluate the efficacy of a newly developed, non-expensive and non-commercial perioperative PTH-assay as indicator of successful surgery in minimally invasive adenomectomy (MIA) for primary hyperparathyroidism (pHPT).

Methods: A chemoluminescence-based PTH-assay was modified to significantly shorten the incubation time, producing results in a total of 45-60 minutes. Its reliability was tested in 19 patients undergoing MIA for pHPT. Patients were selected for MIA based on preoperative imaging including ultrasound and CT. After verification of its reliability, the PTH assay was incorporated into our treatment protocol and its results registered and correlated with serum calcium levels and surgical outcome.

Results: The PTH assay was found to fully correlate with the current gold standard, i.e. serum calcium levels on the first postoperative day after MIA. It was subsequently used in 55 patients selected for MIA, as well as in 26 patients undergoing conventional neck exploration (CNE). In all cases it correctly indicated surgical failure/success. The conventional re-exploration that was required in 3 patients after unsuccessful MIA, was also correctly interpreted on the basis of the PTH-assay. In 2 cases an unexpected delay was encountered in the decline of PTH-levels following adenomectomy.

Conclusion: The perioperative PTH-assay described is a reliable, inexpensive, and relatively fast predictor of surgical outcome, and should be considered essential for minimally invasive surgery in patients with pHPT.