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. 2002 Oct;15(4):363-5.
doi: 10.1080/08998280.2002.11927865.

Surgical treatment of hyperparathyroidism using the quick parathyroid assay

Stacy L Stratmann  1 , Joseph A Kuhn, John T Preskitt, John C O'Brien, Jeffrey S Stephens, Todd M McCarty
Affiliations

Surgical treatment of hyperparathyroidism using the quick parathyroid assay

Stacy L Stratmann et al. Proc (Bayl Univ Med Cent). 2002 Oct.

Abstract

The quick intraoperative parathyroid assay (qPTH) has been proposed as an effective tool in the surgical management of hyperparathyroidism. By measuring intact parathyroid hormone intraoperatively, the qPTH assay may facilitate directed exploration for solitary adenomas and may help guide the extent of resection in hyperplasia. In this study, results of the qPTH assay were analyzed prospectively in 63 consecutive patients who underwent exploration for hyperparathyroidism. Blood samples were drawn prior to surgical incision, prior to gland excision, and 5 and 10 minutes after gland excision. A decline >/=50% of the highest preincision or preexcision level within 10 minutes of resection was considered successful. Forty-nine patients (78%) had a solitary parathyroid adenoma. The qPTH assay was successful in 48 (98%) of these patients. One patient showed a delayed decline at 20 minutes. Fourteen patients (22%) had multiglandular disease: 6 with primary hyperplasia, 4 with hyperplasia secondary to renal failure, and 4 with double adenomas. The assay was successful in all of these patients. It detected multiglandular disease in 8 of 14 patients thought preoperatively to have solitary adenoma. Overall, the qPTH assay was successful in 62 of 63 patients (98%). All patients were normocalcemic after a median follow-up interval of 8 months. These data suggest that the qPTH assay can accurately facilitate directed neck exploration for solitary adenomas, guide the extent of resection for hyperplasia, and identify unknown multiglandular disease. It appears to eliminate the most common cause of parathyroidectomy failure, thereby improving surgical success rates while potentially decreasing morbidity, cost, and operative time.

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Figures

Figure 1
Figure 1
qPTH assay values in a patient with a single adenoma.
Figure 2
Figure 2
qPTH assay values in a patient with delayed decline in qPTH level.
Figure 3
Figure 3
qPTH assay values in a patient with renal failure who underwent 31/2 gland resection.
Figure 4
Figure 4
qPTH assay values in a patient whose sestamibi scan inaccurately suggested single adenoma. The patient was found to have a double adenoma.
See this image and copyright information in PMC

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