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Intraoperative calcium monitoring is insufficient to predict the surgical success of parathyroidectomy for primary hyperparathyroidism

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Abstract

Purpose

Serum calcium has been suggested to be a surrogate marker for intraoperative monitoring during a parathyroidectomy (PTX) for primary hyperparathyroidism (pHPT). The objective of the present prospective study was to investigate whether serum calcium can be used as an alternative for parathyroid hormone intraoperative monitoring.

Methods

Intact parathyroid hormone (iPTH), total and ionized serum calcium, total protein (tP), and pH were monitored in parallel in 25 patients during a successful directed PTX for pHPT.

Results

All patients had at least a 50% decrease of iPTH 10 min after PTX. Simultaneously measured total serum calcium (tCa) and ionized serum calcium (iCa) did not correlate with iPTH or pH. However, tCa and iCa levels correlated with changes in tP (r = 0.859; P < 0.001; r = 0.483; P = 0.014). In addition, intraoperative iCa changes correlated with preoperative iCa levels (r = −0.475, P = 0.016). A linear regression analysis for parameters potentially infl uencing intraoperative tCa and iCa dynamics changes identifi ed tP changes as the only parameter infl uencing tCa and iCa changes (P < 0.001).

Conclusion

Individual short-term intraoperative changes of tCa or iCa are not predictive for successful PTX, as they more likely refl ect changes in intraoperative fl uid management rather than decreased iPTH.

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Authors and Affiliations

  1. Department of General and Visceral Surgery, University Hospital Muenster, Waldeyerstrasse 1, 48149, Muenster, Germany

    Peter Gassmann, Norbert Senninger & Mario Colombo-Benkmann

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  1. Peter Gassmann
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  2. Norbert Senninger
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  3. Mario Colombo-Benkmann
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Gassmann, P., Senninger, N. & Colombo-Benkmann, M. Intraoperative calcium monitoring is insufficient to predict the surgical success of parathyroidectomy for primary hyperparathyroidism. Surg Today 40, 1123–1128 (2010). https://doi.org/10.1007/s00595-009-4191-6

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  • DOI: https://doi.org/10.1007/s00595-009-4191-6

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