Document Detail


Assessing the impact of low baseline parathyroid hormone levels on surgical treatment of primary hyperparathyroidism.
MedLine Citation:
PMID:  19418534     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES/HYPOTHESIS: To compare patients with a parathyroid hormone index (iPTH) level less than 100 pg/mL (low baseline) with patients with an index level greater than 100 pg/mL (high baseline) relative to intraoperative iPTH levels (IOPTH), surgical findings, imaging, and outcome. STUDY DESIGN: Retrospective chart review. METHODS:: The medical records of 284 patients with primary hyperparathyroidism undergoing parathyroid exploration utilizing IOPTH were reviewed. One hundred fifty-eight patients with a low baseline iPTH level were compared with 144 patients with a high baseline iPTH level. Patients were correlated in regard to IOPTH results, surgical findings, preoperative localization imaging, and surgical outcome. RESULTS: There was no significant difference between the two groups in regard to recalcitrant disease. Twenty percent of the low baseline group of patients had multigland disease, versus 8% of the high baseline patients. The kinetic profile of iPTH degradation differed between the two groups, with the low baseline group demonstrating a significantly lower percentage drop compared to the high baseline group. CONCLUSIONS: Patients with preoperative low baseline iPTH levels are over two times more likely to have multigland disease than patients with high baseline levels. Preoperative imaging in this group appears to be less likely to yield a solitary adenoma, even in the absence of multigland disease. IOPTH degradation kinetics is variable between groups, resulting in the possibility of inconsistent correlation with complete resection. These findings suggest that the current IOPTH guidelines, with reference to adequacy of resection, may need to be amended, especially for patients with low baseline iPTH levels. Laryngoscope, 2009.
Authors:
M Jonathan Clark; Phillip K Pellitteri
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Laryngoscope     Volume:  119     ISSN:  1531-4995     ISO Abbreviation:  Laryngoscope     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-05-26     Completed Date:  2009-06-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8607378     Medline TA:  Laryngoscope     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1100-5     Citation Subset:  IM    
Affiliation:
Department of Otolaryngology, Geisinger Medical Center, Danville, Pennsylvania 17822-1333 , USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Calcium / blood
Female
Follow-Up Studies
Humans
Hyperparathyroidism, Primary / blood,  surgery*
Male
Middle Aged
Neoplasms, Multiple Primary / blood,  surgery*
Parathyroid Hormone / blood*
Parathyroid Neoplasms / blood,  surgery*
Parathyroidectomy*
Postoperative Complications / blood
Reoperation
Retrospective Studies
Chemical
Reg. No./Substance:
0/Parathyroid Hormone; 7440-70-2/Calcium

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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