Abstract
Methods 112 patients (of which 72.3% females) underwent MIP by the same surgeon. Age, sex, body mass index (BMI), pre- and postoperative serum calcium, creatinine, 25(OH)D levels, PTH at baseline (PTH T0), and PTH at 10 minutes after adenoma resection (PTH T10) were recorded. Both PTH 2G and PTH 3G assays were assessed using the Diasorin assays. Results The mean age was 56.1 ± 14.7 years. Mean value of BMI, preoperative calcium, 25(OH)D, and CKD-EPI-eGFR were, respectively, 26.8 ± 4.8 kg/m2, 110.9 ± 7.9 mg/L, 19.3 ± 9.2 ng/mL, and 88.6 ± 25.6 mL/min/1.73 m2. PTH 2G and PTH 3G assays were well correlated at PTH T0 and PTH T10 (respectively, correlation coefficient 0.74 and 0.72 for intraclass correlation type 3). The median PTH fall was, respectively, of 79.9% and 82.5% for PTH 2G and PTH 3G. Multivariate analysis using the combined PTH 2G and PTH 3G as a dependent variable with 2 repeated measurements (at PTH 0 and PTH 10) showed a significant effect of preoperative calcium on IOPTH fall (p=0.001, effect size 0.13), while no significant effects were observed for sex, age, BMI, and 25(OH)D. Conclusion PTH 2G and PTH 3G assays resulted in a similar drop in IOPTH values. Elevated preoperative calcium levels are the only independent predictor of IOPTH decline. Further studies are needed to determine other factors that can influence PTH kinetics.
Highlights
Primary hyperparathyroidism (PHPT) is most frequently caused by a single adenoma localized in one of the parathyroid glands [1]
Managed by bilateral surgical neck exploration, PHPT is nowadays treated by minimally invasive parathyroidectomy (MIP). is change was primarily driven by the accuracy of preoperative localization tests allowing a unilateral neck exploration with a limited operative time, sometimes using just a cervical block with sedation [1,2,3]. e incorporation of intraoperative measurements of PTH (IOPTH) has facilitated MIP and reduced the need for further unnecessary explorations [4]. e Miami criterion for a successful parathyroidectomy was defined as a fall of IOPTH by more than 50% of its initial value, within 10 to 15 minutes after removal of the adenoma [5]. e IOPTH value drawn at 10 minutes following parathyroidectomy is the most accurate predictor of a successful MIP [6, 7]
MANCOVA analysis revealed that 25(OH)D and preoperative calcium levels are independently associated with the combined PTH 2G and PTH 3G assay variable (p 0.016, effect size 0.094 for 25(OH)D; p 0.017, effect size 0.093 for preoperative calcium levels), while the other variables did not achieve significance
Summary
Primary hyperparathyroidism (PHPT) is most frequently caused by a single adenoma localized in one of the parathyroid glands [1]. E Miami criterion for a successful parathyroidectomy was defined as a fall of IOPTH by more than 50% of its initial value, within 10 to 15 minutes after removal of the adenoma [5]. E IOPTH value drawn at 10 minutes following parathyroidectomy is the most accurate predictor of a successful MIP [6, 7]. Age, impaired renal function [8], race (African American vs others) [9], and high BMI [10] were shown to be negative predictors of IOPTH decline following MIP, while low 25 hydroxyvitamin D (25(OH)D) levels have been shown to either increase IOPTH drop [11] or have no effect [12, 13]. Despite lower values in PTH 3G assays compared to PTH 2G (approximately 30 to 50% lower) [17, 20,21,22], both assays demonstrated a strong correlation in patients with normal renal function [20, 23] and on hemodialysis [22, 24], even if the difference between both methods increases when PTH values are high [23, 24]
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