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Influence of common clinical variables on intraoperative parathyroid hormone monitoring during surgery for primary hyperparathyroidism

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Abstract

Background

Intraoperative monitoring of parathyroid hormone (IOPTH) is a reliable method of predicting the cure of primary hyperparathyroidism (PHPT). The aim of this study is to assess whether common clinical variables (CCV) frequently encountered in patients with PHPT may affect the magnitude of PTH drop or the likelihood of patients meeting the intraoperative cure criterion.

Design

Patients who were surgically cured from PHPT caused by single gland disease (SGD) and had full IOPTH protocol (4 measurements) were stratified according to age, gland weight, renal function, vitamin D status and severity of hypercalcemia. The percentage of IOPTH drop and the frequency of patients who had true positive IOPTH test results were compared among groups.

Results

762 patients had surgery for PHPT, of whom 746 were (98%) cured. Of these 746 patients, 511 who had SGD and a full IOPTH protocol were included in this study. The median IOPTH drop was significantly higher among younger patients, those with severe hypercalcaemia at 5, 10, 15 min after gland excision, giant glands (at 5-min only), patients with vitamin D deficiency (at 10, 15 min), and those with normal renal function (at 15 min only). The likelihood of the patients meeting the intraoperative cure criterion was not significantly affected among the groups except in patients with mild hypercalcaemia, who were significantly less likely to have 50% IOPTH drop than those with severe hypercalcaemia at all time points. The frequency of mildly hypercalcaemic patients who met cure criterion was significantly improved by extending measurement to 15 min.

Conclusions

IOPTH monitoring has the ability to mitigate the variability of IOPTH kinetics associated with most clinical variables. Mildly hypercalcemic patients in particular may benefit from waiting for 15-min measurement before any surgical decision is made.

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Acknowledgement

M.S.S. would like to thank the Ministry of Higher Education, Missions sector, Egypt and the British Council for their support through Newton‐Musharafa programme via the Egyptian Cultural Bureau in London.

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Authors and Affiliations

  1. Centre for Endocrine Surgery, University College London Hospital and London Clinic, 250 Euston Road, London, NW1 2PG, UK

    M. S. Shawky, T. E. Abdel-Aziz, M. C. De Jong, V. Rozalén García & T. R. Kurzawinski

  2. Department of General Surgery, Alexandria University, Alexandria, Egypt

    M. S. Shawky, M. F. Sakr, A. S. Nabawi & T. E. Abdel-Aziz

  3. Department of Clinical Biochemistry, University College London Hospital, London, UK

    F. Lam, C. Soromani & J. W. Honour

  4. Department of Anaesthesia, University College London Hospital, London, UK

    J. Smart

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  1. M. S. Shawky
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  2. M. F. Sakr
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Contributions

MS Shawky: study conception and design; acquisition, analysis and interpretation of data; drafting of manuscript. MF Sakr: interpretation of data, critical revision. AS Nabawi: interpretation of data, critical revision. TE Abdel-Aziz: study conception and design; critical revision. MC de Jong: acquisition of data; analysis of data. V Rozalén García: acquisition of data; analysis and interpretation of data. F Lam: acquisition of data; analysis and interpretation of data. C Soromani: acquisition of data; analysis and interpretation of data. J Smart: acquisition of data, critical revision. JW Honour: ioPTH service initiation, review of data and manuscript. TR Kurzawinski: analysis and interpretation of data; drafting of manuscript.

Corresponding author

Correspondence to M. S. Shawky.

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The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.

Research involving human participants and/or animals

The study was approved by the institutional research committee. This article does not contain any studies on animals performed by any of the authors.

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Patients were not consented for this study due to its retrospective nature.

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Shawky, M.S., Sakr, M.F., Nabawi, A.S. et al. Influence of common clinical variables on intraoperative parathyroid hormone monitoring during surgery for primary hyperparathyroidism. J Endocrinol Invest 43, 1205–1212 (2020). https://doi.org/10.1007/s40618-020-01201-z

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  • DOI: https://doi.org/10.1007/s40618-020-01201-z

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