October - December 2015, Volume 11, Issue 4

Velicescu C, Branisteanu D, Grigorovici A, Gatu A, Preda C, Mogos V, Danila R

Quick Intraoperative PTH Assay Improves Cure Rate of Minimally Invasive Surgery in Patients with Primary Hyperparathyroidism

Acta Endo (Buc) 2015, 11 (4): 457-462
doi: 10.4183/aeb.2015.457

Purpose. We checked the advantage of intraoperative quick PTH (iqPTH) for improving cure rate of patients operated for primary hyperparathyroidism (PHPTH) by using minimally invasive surgery. Methods. We compared two groups of patients diagnosed with PHPTH by preoperatory localized single parathyroid adenoma (PA) submitted to minimal invasive surgery with histological confirmation. Patients from a control group (C) were operated without measuring intraoperative PTH, whereas in the second group iqPTH was assessed after adenoma excision and before wound suture. When quick PTH dropped less than 50%, conversion to open surgery and bilateral exploration followed. Results. Six of the 40 patients from the C group (15%) had persistently elevated postoperative PTH, needing reintervention. High intraoperative PTH levels persisted in two of the 13 patients from the iqPTH group (15.4%), but conversion to open surgery allowed localizing and excision of preoperatory undetected supplementary PA, increasing success rate to 100% (p < 0.05). Conclusions. Assessment of iqPTH in PHPTH before wound suture provides reliable confirmation of accurate adenoma removal. Persistence of high PTH levels after adenoma removal suggests multiple gland disease and requires conversion to bilateral neck exploration in order to increase cure rate.

Keywords: quick PTH, primary hyperparathyroidism, surgery, minimally invasive, cure.

Correspondence: Dumitru Branisteanu MD, “Gr.T.Popa” University of Medicine and Pharmacy, Dept. of Endocrinology, 18 Vasile Conta Street, Ia?i, 700106, Romania, E-mail: dumitru_branisteanu@yahoo.com