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Impact of Intraoperative Parathyroid Hormone Levels on Surgical Results in Patients with Renal Hyperparathyroidism

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Abstract

The aim of our study was to evaluate the impact of intraoperative parathyroid hormone (PTH) measurement on surgical results in patients with renal hyperparathyroidism (HPT). From December 1999 to February 2004, a series of 95 consecutive patients underwent total parathyroidectomy and intraoperative PTH measurement for renal HPT. Intraoperative PTH was measured before and 15 minutes after parathyroidectomy with the Immulite DPC assay for intact PTH. The median PTH levels before surgery were 133.0 pmol/L, which declined to 5.9 pmol/L at the end of the operation. At follow-up, 91 of 95 (96%) patients presented with normal calcium levels. Persistent renal HPT was seen in three patients, and recurrent HPT was diagnosed in another. In 99% of the patients the intraoperative PTH levels declined more than 50% and in 73% the PTH decay was more than 90%. In 64% of the patients PTH levels dropped into the normal range (< 7.6 pmol/L). Altogether, 97% of the patients with an intraoperative PTH decrease of more than 90% presented with normal PTH levels postoperatively (p = 0.0237), as did all of the patients whose intraoperative PTH dropped into the normal range (p = 0.0432). Intraoperative PTH measurement with a decrease in intraoperative PTH of at least 90% is highly predictive of successful parathyroidectomy and normalization of postoperative calcium and PTH levels.

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Authors and Affiliations

  1. Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany

    Theresia Weber M.D., Ulf Hinz M.Sc. & Markus W. Büchler M.D.

  2. Department of Nephrology, University of Heidelberg, Im Neuenheimer Feld 162, Heidelberg, 69120, Germany

    Martin Zeier M.D.

  3. Department of Endocrinology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany

    Tobias Schilling M.D.

Authors
  1. Theresia Weber M.D.
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  2. Martin Zeier M.D.
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  3. Ulf Hinz M.Sc.
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  4. Tobias Schilling M.D.
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  5. Markus W. Büchler M.D.
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Correspondence to Theresia Weber M.D..

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Weber, T., Zeier, M., Hinz, U. et al. Impact of Intraoperative Parathyroid Hormone Levels on Surgical Results in Patients with Renal Hyperparathyroidism. World J. Surg. 29, 1176–1179 (2005). https://doi.org/10.1007/s00268-005-7805-1

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  • DOI: https://doi.org/10.1007/s00268-005-7805-1

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