Usefulness of intraoperative parathyroid hormone measurements in patients with renal hyperparathyroidism.
until further notice
SourceHead and Neck-Journal for the Sciences and Specialties of the Head and Neck, 32, 10, (2010), pp. 1328-1335
1 oktober 2010
Article / Letter to editor
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Laboratory of Genetic, Endocrine and Metabolic Diseases
Epidemiology, Biostatistics & HTA
Head and Neck-Journal for the Sciences and Specialties of the Head and Neck
SubjectIGMD 6: Hormonal regulation; NCEBP 1: Molecular epidemiology; NCEBP 2: Evaluation of complex medical interventions; IGMD 9: Renal disorder
BACKGROUND: In renal hyperparathyroidism, it remains unclear whether intraoperative parathyroid hormone (PTH) measurements can predict postoperative outcome and guide the extent of surgical exploration. METHODS: In 42 parathyroidectomies for renal hyperparathyroidism, we analyzed the predictive value of the Miami Criterion of 50% intraoperative PTH decrease. We used receiver operating characteristic (ROC) curves to find the criterion with the best diagnostic performance. We also investigated whether the whole PTH assay improved accuracy. RESULTS: Twenty-six operations (62%) resulted in normal postoperative PTH. With the Miami Criterion, cure was predicted with a sensitivity of 95% and specificity of only 8%. Specificity could be improved to 50% using a 70% PTH decrease as cut-off level. The whole PTH assay did not improve accuracy. CONCLUSION: Prediction of cure after parathyroidectomy for renal hyperparathyroidism might be improved with a criterion of 70% PTH decrease 10 minutes after excision of all parathyroid glands. Prospective analysis needs to validate this new criterion.
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