On-line version ISSN 2078-5151
S. Afr. j. surg. vol.49 n.3 Cape Town Aug. 2011
A. N. MorksI; T. M. van GinhovenII; J. M. PekelharingIII; E. J. J. DuschekIV; P. C. SmitV; P. W. de GraafV
IM.D.; Department of Surgery, Reinier de Graaf Hospital, Delft, The Netherlands
IIM.D.; Ph.D.Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
IIIM.D.; Ph.D.Department of Clinical Chemistry, Reinier de Graaf Hospital
IVM.D.; Ph.DDepartment of Endocrinology, Reinier de Graaf Hospital
VM.D.; Ph.D.Department of Surgery, Reinier de Graaf Hospital
BACKGROUND: Surgery is the treatment of choice for symptomatic primary hyperparathyroidism. The majority of research concerning intra-operative parathyroid hormone (ioPTH) measurements is conducted in university hospitals. Whether ioPTH measurements are feasible and useful in predicting the presence of remaining hyperfunctioning parathyroid tissue in a non-academic hospital remains uncertain.
METHODS: Data were collected on all patients with biochemically proven and surgically treated primary hyperparathyroidism treated at the Reinier de Graaf Hospital from August 2002 to December 2007.
RESULTS: Sixty-five patients were included. The mean pre-operative serum calcium level was 2.78 mmol/l (range 2.28 - 3.80 mmol/l, normal range 2.20 - 2.65 mmol/l) and the mean serum parathyroid hormone level 17.0 pmol/l (range 4.0 - 90.3 pmol/l, normal range 1.0 - 5.5 pmol/l). All patients were operated on for primary hyperparathyroidism, using ioPTH measurements during their first operation. Sensitivity and specificity rates of ioPTH measurements were 98% and 89%, respectively. The ioPTH test accurately indicated incomplete removal of all hyperfunctioning parathyroid tissue in 8 patients (12%). Five patients (8%) were re-explored immediately, of whom 4 were successfully treated in this single operative session. One patient was operated on successfully the next day. Two patients were operated on with a successful result during a second admission. In all the ioPTH measurements there was 1 false-positive result (1.5%) and 1 false-negative result (1.5%).
The mean postoperative calcium value for the successfully treated patients was 2.34 mmol/l (range 2.14 - 2.71 mmol/l, normal range 2.20 - 2.65 mmol/l). The mean postoperative PTH level for the successfully treated patients was 3.76 pmol/l (range 0.40 - 7.1 pmol/l).
CONCLUSION: Our data suggest that ioPTH measurements are feasible and useful in a non-academic hospital.
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