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Paper 13 (0800)
THE ROLE OF INTRAOPERATIVE PARATHYROID HORMONE TESTING IN PATIENTS WITH TERTIARY HYPERPARATHYROIDISM AFTER RENAL TRANSPLANTATION
Background: Intraoperative parathyroid hormone (PTH) testing has been shown to accurately define adequacy of parathyroid resection in patients with primary hyperparathyroidism (HPT), and alters the operative management in 10-15% of cases. However, the benefit of this technique in patients with tertiary HPT after renal transplantation undergoing parathyroidectomy is unclear.
The 26th Annual Meeting of the American
Association of Endocrine Surgeons
April 3rd- 5th,2005 - Paradisus Riviera Cancun.
S. V. Haustein, MD, Eberhard Mack, MD, James R. Starling, MD, and Herbert Chen, MD
University of Wisconsin, Madison, WI
Methods: Intraoperative PTH was measured in 32 consecutive patients undergoing parathyroidectomy for tertiary PTH after renal transplantation between 3/01-11/04 using the Elecsys assay at baseline and, subsequently, five, ten, and fifteen minutes after curative resection. The outcomes of these patients were evaluated.
Results: All patients were cured after surgery. Of the 32 patients, 30 were found to have parathyroid hyperplasia while 2 had double adenomas. The average drop in intraoperative PTH levels after curative resection was 69±3.5% at 5 min., 77±2.3% at 10 min, and 83±3.4% at 15 min. PTH testing changed the intraoperative management in five patients (16%). Two patients with double adenomas had a > 50% drop at 10 min. after excision; therefore the operation was terminated without further exploration. Three patients did not have a > 50% drop at 10 min. after 3.5 gland resection. These patients were further explored and additional supernumerary parathyroid glands were identified and resected. After resection of these additional glands, the PTH fell by >50% indicating cure.
Conclusions: In patients undergoing parathyroidectomy for tertiary HPT after renal transplantation, a decrease in intraoperative PTH levels > 50% at ten minutes after completion of the operation indicates adequate resection. Furthermore, intraoperative PTH testing altered the operative management in 16% of patients. Therefore, similar to its role in patients with primary HPT, intraoperative PTH testing appears to play an equally important role in the management of patients with tertiary HPT undergoing parathyroidectomy.