Endocrine Abstracts

Introduction: Intraoperative quick PTH (iqPTH) monitoring is important in the treatment of primary hyperparathyroidism (pHPTH), allowing, together with preoperative localisation, the switch from routine bilateral neck exploration to limited gland excision.

Aims: We checked the advantage of iqPTH for improving the cure rate of patients operated for pHPTH by using minimally invasive surgery (MIS).

Materials and methods: Retrospective study comparing two groups of patients with pHPTH caused by isolated sporadic parathyroid adenomas localised before surgery with sesta-MIBI scintigraphy and ultrasound. All patients were operated by MIS. Adenoma excision was histologically confirmed. The 40 patients from the first group (control, C) were operated without measuring iqPTH, whereas iqPTH and serum calcium were assessed in the second group (iqPTH) of 13 patients 5 min after the excision of the adenoma and before wound suture. When iqPTH dropped <50% the pre-excision value, MIS was converted to open neck surgery.

Results: Six out of the 40 patients from the C group (15%) had persistent hypercalcemia and elevated PTH at 24 h, 3 and 6 months after surgery, needing reintervention. Eleven out of the 13 patients from the iqPTH group had an important drop of iqPTH after adenoma excision, whereas two of them (15.4%) persisted having high iqPTH levels. Conversion to open neck surgery allowed localising a preoperatory undetected supplementary parathyroid adenoma in both cases. Excision of the second adenoma allowed PTH normalization and cure in only one surgical intervention, thereby increasing success rate to 100% in the iqPTH group (P<0.05).

Conclusion: The addition of an iqPTH assay to MIS provides a quick and reliable intraoperative confirmation of accurate adenoma removal. iqPTH is able to distinguish between single and multiple gland disease. Persistence of high iqPTH indicates conversion to bilateral neck exploration, thereby increasing cure rate in the same intervention.

Disclosure: This work was supported by the European Social Found, Human Resources Development Operational Programme 2007–2013, project no. POSDRU/159/1.5/S/136893.