INTRAOPERATIVE SERUM PARATHORMONE MEASURE MENT IN THE SURGICAL-TREATMENT OF HYPERPARATHYROIDISM

BACKGROUND: PTH(1-84) short half life permits us to monitor parathyroi dectomy efficacy, confirming complete resection after unilateral surgi cal approach in some cases of primary hyperparathyroidism. Nevertheles s, this utility has not been tested in controlled clinical trials and there is no agreement regarding the extraction of samples, their proce ssing and interpretation of results. PATIENTS AND METHODS: In 18 conse cutive patients operated on for primary or secondary hyperparathyroidi sm, serum PTH(1-84) concentrations were assessed at different times be fore, during and after partial (in 11 patients with multiglandular ill ness) and total resections. RESULTS: Initial PTH(1-84) concentrations vary largely in different pre-resection samples, and these variations significantly affect post-resection percentage reduction. Plasmatic cl earance of PTH(1-84) after incomplete resection follows a decreasing e xponential curve towards new equilibrium concentrations. The differenc e is significant comparing with concentrations following complete rese ction only 5 minutes after, but the 95% intervals with a confidence le vel of 90% of confidence are exclusive only for determinations after 1 20 minutes. CONCLUSIONS: The decrement of serum PTH(1-84) concentratio ns to 20% of the preresection levels 120 minutes after an adenomectomy confirms the complete removal of all pathologic parathyroid tissue. A less sharp decrement must be investigated and may justify an early su rgical revision.