LATERALIZATION OF PARATHYROID ADENOMAS BY INTRAOPERATIVE PARATHORMONEESTIMATION

A simple method for intra-operative lateralization of parathyroid aden omas by venous sampling for intact parathormone (PTH [1-84] is describ ed. After induction of anaesthesia, percutaneous right and left intern al jugular and arm vein PTH [1-84] nas estimated within 30 minutes by a modification of the Allegro PTH [1-84] assay. Twenty-three patients with primary hyperparathyroidism due to adenoma rs ere explored, 21 wi th one adenoma and two with two adenomas. Intraoperative jugular PTH [ 1-84] correctly lateralized 16 (76%) of the single adenomas (P < 0.006 ), and the side of the neck with the greater weight of parathyroid ade noma in 18 (78%) patients (P < 0.004). Two patients with previous fail ed neck explorations were correctly lateralized. Thallium/technetium s canning lateralized 41%, significantly less then jugular PTH [1-84] (P < 0.02). Adenomas of 1 g or less were more likely to be lateralized b y PTH [1-84] than thallium/technetium scanning (P < 0.05). Intraoperat ive jugular PTH [1-84] was superior to thallium/technetium scanning fo r parathyroid adenoma lateralization.