Document Detail


Minimally invasive surgery for primary hyperparathyroidism with or without intraoperative parathyroid hormone monitoring.
MedLine Citation:
PMID:  20823623     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We analyzed the utility of intraoperative parathyroid hormone (IOPTH) monitoring in minimally invasive surgery for primary hyperparathyroidism (pHPT). The subjects were the 167 consecutive patients with pHPT performed initial operation with or without IOPTH between January 2000 and December 2006. Patients were divided into 2 groups. A group who underwent surgery without IOPTH monitoring (Group 1; n=87), and a group who underwent surgery with IOPTH monitoring (Group 2; n=80), in which IOPTH was measured at 5, 10, 15 minutes after excision of the abnormal parathyroid gland. Criterion for evaluation as a cure was a drop in intact PTH level of 50% or more from the preoperative baseline value. The overall cure rate in Group 1 was 93.1%. An enlarged parathyroid gland that was consistent with the results of a preoperative imaging study was found in 84 patients (96.6%). The overall cure rate in Group 2 was 97.5%. In 7 of the patients, there was no drop of 50% or more at any of the 3 points in time measured. Two of these patients were found to have had double adenomas, one on each side, during the initial surgery. Three others were eucalcemic and had normal intact PTH values after surgery, and the remaining 2 patients had persistent disease. Although preoperative localization studies are accurate and essential, IOPTH monitoring improves the cure rate of minimally invasive parathyroidectomy. IOPTH monitoring is a valuable adjunct to achieve adequate intraoperative decision-making, recognizing and resecting additional image-negative hyperfunctioning lesions.
Authors:
Kiminori Sugino; Koichi Ito; Mitsuji Nagahama; Wataru Kitagawa; Hiroshi Shibuya; Keiko Ohkuwa; Yukiko Yano; Kunihiko Ito
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Publication Detail:
Type:  Journal Article     Date:  2010-09-02
Journal Detail:
Title:  Endocrine journal     Volume:  57     ISSN:  1348-4540     ISO Abbreviation:  Endocr. J.     Publication Date:  2010  
Date Detail:
Created Date:  2010-12-07     Completed Date:  2011-04-11     Revised Date:  2011-06-16    
Medline Journal Info:
Nlm Unique ID:  9313485     Medline TA:  Endocr J     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  953-8     Citation Subset:  IM    
Affiliation:
Surgical Branch, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, Japan. k-sugino@ito-hospital.jp
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Female
Humans
Hyperparathyroidism, Primary / blood*,  surgery*
Male
Middle Aged
Monitoring, Intraoperative / methods
Parathyroid Hormone / blood*
Parathyroidectomy / methods*
Young Adult
Chemical
Reg. No./Substance:
0/Parathyroid Hormone

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


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