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Intraoperative Parathormonmessung bei Hyperparathyreoidismus

Intraoperative measurement of parathyroid hormone in hyperparathyroidism

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Zusammenfassung

Die intraoperative Parathormonbestimmung (IOPTH) beruht auf der kurzen Halbwertszeit des Parathormons (PTH) und der schnellen Analysetechnologien. Ihre funktionelle Aussage über die Korrektur des Überfunktionszustandes beim Hyperparathyreoidismus (HPT) ist der makroskopischen Einschätzung der Nebenschilddrüse (NSD), aber auch jeder (Schnellschnitt‑)Histologie überlegen (sog. biochemischer Schnellschnitt). Im Folgenden wird die Relevanz und Bewertung der IOPTH für die wichtigsten HPT-Formen, den primären HPT, den renalen sekundären und tertiären HPT, die multiple endokrine Neoplasie (MEN1) sowie das Nebenschilddrüsenkarzinom, und klinische Szenarien anhand der aktuellen Datenlage eingeordnet. Es wird deutlich, dass der Zusatznutzen der IOPTH von diversen Voraussetzungen der HPT-Form, der Diagnostik sowie auch patientenindividueller und resektionsstrategischer Überlegungen abhängt. Dabei sind die Kosten der IOPTH vergleichsweise gering und erscheinen im Hinblick auf den Qualitätsgewinn gerechtfertigt. In der Hand des spezialisierten endokrinen Chirurgen ist die IOPTH ein unverzichtbares Instrument der intraoperativen Entscheidungsfindung und Qualitätssicherung.

Abstract

Intraoperative parathyroid hormone (IOPTH) determination is based on the short half-life of parathyroid hormone (PTH) and the rapid analytical technology. The IOPTH provides functional information regarding correction of the overproductive state in hyperparathyroidism (HPT) and is superior to macroscopic evaluation of the parathyroid gland (PG) as well as any (intraoperative frozen section) form of histology (so-called biochemical frozen section). In this article the relevance and evaluation of IOPTH is defined for the most important forms of HPT, for primary HPT, renal secondary and tertiary HPT, multiple endocrine neoplasia type 1 (MEN1) and parathyroid carcinoma and clinical scenarios based on the currently available data. It becomes apparent that the additional benefits of IOPTH depend on diverse prerequisites of the specific type of HPT, the diagnostics as well as individual patient factors and strategic considerations for resection. Overall, the costs for IOPTH are comparably low and seem to be justified with respect to the gain in quality. In the hands of specialized endocrine surgeons IOPTH is an essential tool for intraoperative decision-making and quality assurance.

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  1. Klinik für Viszeral‑, Gefäß- und Endokrine Chirurgie, Universitätsklinikum Halle, Martin-Luther Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle an der Saale, Deutschland

    K. Lorenz, R. Schneider & M. Elwerr

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Lorenz, K., Schneider, R. & Elwerr, M. Intraoperative Parathormonmessung bei Hyperparathyreoidismus. Chirurg 91, 448–455 (2020). https://doi.org/10.1007/s00104-020-01123-9

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