Intraoperative PTH cutoff definition to predict successful parathyroidectomy in secondary and tertiary hyperparathyroidism

被引:46
作者
Ohe, Monique Nakayama [1 ,2 ]
Santos, Rodrigo Oliveira [3 ]
Kunii, Ilda Sizue [4 ]
Carvalho, Aluizio Barbosa
Abrahao, Marcio [3 ,5 ]
das Neves, Murilo Catafesta
Lazaretti-Castro, Marise [2 ,6 ]
Cervantes, Onivaldo
Henriques Vieira, Jose Gilberto [2 ]
机构
[1] Fed Univ Sao Paulo EPM UNIFESP, Paulista Sch Med, Sao Paulo, Brazil
[2] EPM UNIFESP, Sao Paulo, Brazil
[3] EPM UNIFESP, Dept ENT HNS, Sao Paulo, Brazil
[4] EPM UNIFESP, Lab Endocrinol & Metabol, Sao Paulo, Brazil
[5] EPM UNIFESP, HNS Program, Sao Paulo, Brazil
[6] EPM UNIFESP, Osteometab Ward Disorders Course, Endocrinol & Metabol Program, Sao Paulo, Brazil
关键词
hyperparathyroidism; secondary; parathyroid hormone; parathyroidectomy; SURGICAL-MANAGEMENT; HORMONE MEASUREMENT; AUTOTRANSPLANTATION; ASSAY;
D O I
10.5935/1808-8694.20130088
中图分类号
R76 [耳鼻咽喉科学];
学科分类号
100213 ;
摘要
In order to improve success rates in surgery of renal hyperparathyroidism, we evaluated intraoperative PTH (IOPTH) measurement utility. Method: 86 patients underwent total parathyroidectomy with intramuscular presternal autotransplantation from 04/2000 to 10/2009 and were followed for 26.5 months on average (prospective cohort). Patients were divided in secondary (SHPT) and tertiary hyperparathyroidism (THPT). SHPT group was composed by patients under dialysis treatment, THPT group included renal grafted ones. IOPTH (Elecsys-PTH-Immunoassay/Roche) was measured at anesthesia induction (IOPTH-0') and 20 minutes (IOPTH-20') after parathyroidectomy. Results: 80.2% (69/86) presented with 80% decrease or more in the IOPTH-20' and all were cured. In 11/86 patients (12.7%), a lower IOPTH-20' drop (70-79%) was observed, and 2 of them (18.1%) failed to cure. 6/86 (6.9%) patients presented IO-PTH-20' decrease of less than 70%: two were cured, in three a supemumerary/ectopic parathyroid was found and removed, and in one of these six patients, surgery was finished after 4-gland excision and the patient failure to cure. Conclusion: IOPTH-20' decrease of 80% or more compared to IOPTH-0' predicts cure in all renal patients throughout follow-up. A decay of less than 70% points to missed or hyperfunctioning supernumerary gland and is predictive of surgical failure in 66.6%. A marginal IOPTH drop of 70-79% leaves the decision whether or not surgery should be continued up to the experienced surgeon.
引用
收藏
页码:494 / 499
页数:6
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