ECE2015 Eposter Presentations Calcium and Vitamin D metabolism (96 abstracts)
Intraoperative parathyroid hormone monitoring during parathyroidectomy: description of our clinical experience
Mariana Tomé 1 , Guillermo Martinez De Pinillos 2 , Mariola Méndez 2 , Eyvée Arturo Cuéllar 2 , Fernando García 2 , Ignacio Fernández López 2 , Ignacio Fernández Peña 2 , Juan Manuel García De Quirós 2 , Juana Hidalgo 2 , Margarita Rivas 2 , Santiago Durán 2 & Maria Victoria Cózar 2
1Hospital Punta De Europa, Algeciras, Spain; 2Valme University Hospital, Sevilla, Spain.
Introduction: Primary hyperparathyroidism is caused by a single adenoma in 85% of cases. This is why bilateral neck exploration seems to be a very aggressive procedure in a large number of cases. Intraoperative parathyroid hormone (IOPTH) monitoring could be a useful tool in primary hyperparathyroidism surgery allowing a less invasive surgical approach. The aim of our study is to evaluate the possible impact of the measurement of IOPTH during surgery.
Methods: Retrospective study in which we included all patients who underwent parathyroidectomy with IOPTH monitoring between 2008 and 2013. We considered the following variables: preoperative localization techniques; neck exploration (uni or bilateral); prediction of curative parathyroid resection by using MIAMI criteria (>50% drop from highest baseline IOPTH level at 10 min after excision) and cure (normal calcaemia 6 months after surgery). Subsequently, we compared this sample with a group of patients who underwent parathyroidectomy between 2000 and 2002 without IOPTH monitoring.
Results: We studied 115 patients (80.9% females; mean age 57.4±14.1 years). In most cases Technetium-99m-sestamibi scintigraphy was the preferred localization technique (97.4% of patients) with positive result in 76.8% of scintigraphies. 76.5% of patients underwent unilateral neck exploration (100% of them were cured). Following MIAMI criteria we were able to predict curative resection in 97.2% of these patients. 93.9% of the total sample were cured after surgery. We compared this results with a series of 35 patients without IOPTH monitoring (74.3% females, 58.51±9.1 years). We did not find significant differences in cure (93.9% vs 91.4%, P=0.61). However, in the second group 100% of patients underwent bilateral neck exploration (23.5% in IOPTH group, P=0.0005).
Conclusion: By monitoring IOPTH in focused parathyroidectomy it is possible to perform a less invasive surgical approach without reduction in cure rate.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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