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Unexpected Results Using Rapid Intraoperative Parathyroid Hormone Monitoring during Parathyroidectomy for Primary Hyperparathyroidism

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Abstract

Rapid intraoperative parathyroid hormone (RIOPTH) monitoring predicts complete removal of all hypersecreting tissue by means of a significant parathyroid hormone (PTH) decrease. In this study we have tried to provide an explanation for some unexpected results of RIOPTH monitoring observed during a series of 125 conventional parathyroidectomies for primary hyperthyroidism, discussing the possible consequences on the surgical strategy. Three main groups can be recognized: (1) spikes: a PTH increase 10 minutes after removal of the diseased gland was observed in three patients; (2) false-negative results: six patients showed an inadequate PTH decreases at 10 minutes, three of them resulting in cure at 20 minutes (all six patients were cured at follow-up); (3) false-positive results: five patients with multiglandular disease showed a PTH decrease to a cure level despite excision of one adenoma only (in two of these patients a 20-minute sample showed a PTH increase soon after manipulation of the second adenoma). We concluded that the spike, almost certainly a consequence of manipulating the adenoma, when detected should be considered the “true” baseline value. False-negative results are to some extent related to undetected spikes. The assay used for RIOPTH determination and PTH half-life variability may also play a role. A false-negative result usually prolongs the surgical time. False-positive results are usually related to a double adenoma, one functionally prevailing over the other. Because in our experience manipulation of the second adenoma brought a PTH increase detected with RIOPTH monitoring, we believe that the second adenoma should be excised.

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Authors and Affiliations

  1. General Surgery Division, Santa Croce e Carle Hospital, Via M. Coppino 26, Cuneo, 12100, Italy

    Ignazio Emmolo M.D., Herbert Dal Corso M.D. & Felice Borghi M.D.

  2. Endocrinology Division, Santa Croce e Carle Hospital, Via M. Coppino 26, Cuneo, 12100, Italy

    Giorgio Borretta M.D. & Flora Cesario M.D.

  3. Laboratory of Clinical Chemistry, Santa Croce e Carle Hospital, Via M. Coppino 26, Cuneo, 12100, Italy

    Gianluca Visconti M.D.

  4. Oncological Endocrinology, San Giovanni Battista Hospital, Corso Bramante 88/90, Torino, 10126, Italy

    Alessandro Piovesan M.D.

Authors
  1. Ignazio Emmolo M.D.
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  2. Herbert Dal Corso M.D.
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  3. Giorgio Borretta M.D.
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  6. Flora Cesario M.D.
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  7. Felice Borghi M.D.
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Correspondence to Ignazio Emmolo M.D..

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Emmolo, I., Corso, H.D., Borretta, G. et al. Unexpected Results Using Rapid Intraoperative Parathyroid Hormone Monitoring during Parathyroidectomy for Primary Hyperparathyroidism. World J. Surg. 29, 785–788 (2005). https://doi.org/10.1007/s00268-005-7751-y

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