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Langenbeck's Archives of Surgery

, Volume 392, Issue 4, pp 427–430 | Cite as

PTH spikes during parathyroid exploration—a possible pitfall during PTH monitoring?

  • Philipp Riss
  • Klaus Kaczirek
  • Christian Bieglmayer
  • Bruno NiederleEmail author
Original Article

Abstract

Background and aims

Parathyroid hormone (PTH) spikes caused by unintentional manipulation of the hypersecreting glands may lead to interpretation problems in intraoperative PTH monitoring. Their frequency and surgical consequences were evaluated.

Materials and methods

Intraoperative PTH values of 401 patients with primary hyperparathyroidism and single gland disease were analysed. Patients were divided into four groups: extensive increase (>150 pg/ml), moderate PTH increase (<150 pg/ml), no increase (±50 pg/ml) and decrease before excision as referred to the baseline level before skin incision. PTH was measured before and up to 25 min after removal of the enlarged gland.

Results

Twenty-two (5.5%) patients had an extensive and 36 (9%) a moderate intraoperative PTH increase. The PTH decline was prolonged to 15 min in 7 (31.8%) and to 25 min in 12 (54.5%) patients after extensive manipulation and in 9 patients (25%) each after moderate manipulation, respectively. No increase occurred in 162 (40.4%) and a decrease in 181 (45.1%) patients. The surgical approach (bilateral exploration vs open, minimally invasive parathyroidectomy) did not show a difference in the rate of PTH spikes.

Conclusion

PTH spikes often cause a prolonged PTH decline but, when recognized, do not lead to a change in the surgical strategy.

Keywords

Primary hyperparathyroidism Parathyroid hormone Parathyroidectomy Intraoperative monitoring 

Notes

Acknowledgement

The study was supported by “Jubiläumsfonds der Österreichischen Nationalbank” Grant 9307.

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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Philipp Riss
    • 1
  • Klaus Kaczirek
    • 1
  • Christian Bieglmayer
    • 2
  • Bruno Niederle
    • 1
    Email author
  1. 1.Section of Endocrine Surgery, Division of General Surgery, Department of SurgeryMedical University of ViennaViennaAustria
  2. 2.Clinical Institute for Medical and Chemical Laboratory DiagnosticsMedical University of ViennaViennaAustria

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