Importance of intraoperative parathormone measurements for primary hyperparathyroidism with hyperplasia of five glands

While intraoperative parathormone measurements are mandatory for unilateral operations of primary hyperparathyroidism (pHPT), its value for treatment of parathyroid hyperplasia is regarded as insufficient. We report a case of a pHPT with hyperplasia of five glands, in which only the intraoperative a nalysis of parathormone detected the remaining fifth hyperparathyroid gland after extirpation of four enlarged parathyroid glands. We describe technic al problems involved in the tests available today and how the results of th e intraoperative parathormone test need to be interpreted. As several facto rs can influence the decrease in parathormone concentration, a kinetic anal ysis may be more accurate in assessing the adequacy of resection. Therefore , intraoperative parathormone measurements are especially useful and import ant for adequate surgical therapy for pHPT with parathyroid hyperplasia.