Clinical scienceThe additional value of intraoperative parathyroid hormone assessment is marginal in patients with nonfamilial primary hyperparathyroidism: a prospective cohort study
Section snippets
Patients and Methods
The study was performed between March 1999 and August 2010. Prospective data collection of patients undergoing surgery for primary hyperparathyroidism started in March 1999 at the University Medical Center Utrecht (hospital A) and in 2006 at the affiliated Diakonessen Hospital Utrecht (hospital B). Patients with a positive family history or a known multiple endocrine neoplasia syndrome (MEN) were not included in the study: during the study period 26 patients with known MEN syndromes were
Results
During the study period, 119 consecutive patients underwent surgery for nonhereditary pHPT. There were 30 men and 89 women, with a median age of 63 years (range, 20–88 y). Patient characteristics are listed in Table 1.
Preoperative imaging studies visualized a solitary adenoma in 105 patients and suggested multiglandular disease (MGD) in 5 patients, although no abnormality was observed in 9 patients (Fig. 1). A total of 101 of the 105 patients with visualized solitary adenomas were selected for
Comments
In this prospective unselected cohort undergoing surgery for nonfamilial pHPT without using IOPTH sampling, the success rate of the first surgery was 96%. IOPTH would have altered intraoperative decision making in only 2 patients and could have increased the success rate from 95.7% to 97.4%.
The present study assessed the value of the IOPTH measurements prospectively by collecting intraoperative samples but not disclosing IOPTH values during surgery. In addition, the present cohort did not
References (31)
- et al.
Comparison of intraoperative iPTH assay (QPTH) criteria in guiding parathyroidectomy: which criterion is the most accurate?
Surgery
(2003) - et al.
Is intraoperative parathyroid hormone assay mandatory for the success of targeted parathyroidectomy?
J Am Coll Surg
(2007) - et al.
Successful minimally invasive parathyroidectomy for primary hyperparathyroidism without using intraoperative parathyroid hormone assays
Am J Surg
(2006) - et al.
Intraoperative parathyroid hormone measurement during minimally invasive parathyroidectomy: does it “value-add” to decision-making?
J Am Coll Surg
(2006) - et al.
Parathyroidectomy outcomes according to operative approach
Am J Surg
(2007) - et al.
Worldwide trends in the surgical treatment of primary hyperparathyroidism in the era of minimally invasive parathyroidectomy
Arch Surg
(2002) - et al.
Unilateral open and minimally invasive procedures for primary hyperparathyroidism: a review of selective approaches
Langenbecks Arch Surg
(2000) Six hundred fifty-six consecutive explorations for primary hyperparathyroidism
Ann Surg
(2002)- et al.
Quick intraoperative parathyroid hormone assay: surgical adjunct to allow limited parathyroidectomy, improve success rate, and predict outcome
World J Surg
(2004) - et al.
A comprehensive evaluation of perioperative adjuncts during minimally invasive parathyroidectomy: which is most reliable?
Ann Surg
(2005)
Intraoperative parathyroid hormone testing improves cure rates in patients undergoing minimally invasive parathyroidectomy
Surgery
Targeted parathyroidectomy in the era of intraoperative parathormone monitoring
World J Surg
A new approach to parathyroidectomy
Ann Surg
Management changes in primary hyperparathyroidism
JAMA
Shifting incidence of solitary adenomas in the era of minimally invasive parathyroidectomyA multi-institutional study
Ann Surg Oncol
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The authors have no potential conflicts of interest.