PARATHYROID LOCALIZATION BY CATHETERIZATION OF LARGE CERVICAL AND MEDIASTINAL VEINS TO DETERMINE SERUM CONCENTRATIONS OF INTACT PARATHYROID-HORMONE

A success rate of about 90% has been achieved after primary operations for hyperparathyroidism, compared with 60% to 80% in most series of s econdary operations. The present reoperative series involved 29 patien ts who underwent venous catheterization with blood sampling for the de termination of intact parathyroid hormone before undergoing repeat par athyroid surgery. Blood samples were taken from the internal jugular v eins, innominate veins, and superior caval vein. No attempt was made t o perform superselective catheterization of the small neck and mediast inal veins. The reoperations were done by four surgeons who did 1, 2, 13, and 13 of the reoperations, respectively. In all patients, distinc t step-ups in parathyroid hormone concentrations were found. On averag e, the gradient between the highest and lowest value was about 5. Clos e to the location of the step-ups, diseased parathyroid tissue was fou nd in 27 of the patients. In two cases no parathyroid tissue was found , and these patients remained hyperparathyroid postoperatively. They h ad been treated by the surgeon who did only two of the operations. Whe n the step-up was observed in the left innominate vein, we could not d ifferentiate mediastinal from low cervical adenomas. No patient develo ped hypoparathyroidism. To avoid this complication, autotransplantatio n of diseased parathyroid tissue into the abdominal subcutaneous fat w as done in nine patients. No case of recurrent laryngeal nerve paralys is occurred. The introduction of reliable assays for the analysis of p arathyroid hormone can make selective catheterization unnecessary when localizing remaining parathyroid glands in patients with persistent h yperparathyroidism.