SFEBES2016 Poster Presentations Bone and Calcium (20 abstracts)
Initial experience of a newly established intra-operative PTH service
Leoni Lekkakou 1 , Leelavathy Kandaswamy 1 , Alain Rolli 2 , Claire Ford 2 , Andrew Garnham 3 , Catherine Spinou 4 , Lenny Liew 4 & Harit Buch 1
1Department of Diabetes and Endocrinology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK; 2Blood Sciences Department, Royal Wolverhampton Hospitals NHS Trust., Wolverhampton, UK; 3Department of Surgery, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK; 4Department of ENT Surgery, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK.
Background: A minimally invasive approach to primary hyperparathyroidism (PHPT) is equivalent to bilateral exploration when intraoperative parathyroid hormone (iPTH) monitoring is used. We have recently established an iPTH service jointly with Surgical and Clinical Chemistry teams and the aim of the study was to evaluate our initial results with its use.
Patients and methods: We collected data from 18 operations for PHPT from October 2015, including one re-exploration. The patients had mean age 59±15 years, calcium 2.96±0.4 mmol/l, PTH 27.19±21.48 pmol/l. All patients had ultrasound and dual-isotope 99mTc-MIBI/123I subtraction with SPECT/CT acquisition scans; six patients had discordant scans. Time-points for iPTH sampling were: before the skin incision (pre-incision S1), just before the blood supply to the gland is ligated (pre-excision S2), 20-min post-excision (post-excision S3). PTH drop of >50% in S3 from S1 or S2 was used as the criterion to suggest cure. In absence of point-of-care testing, we used Elecsys-E411 analyser (Roche) reserved for PTH-testing after a prior alert. Turnaround time was 35 min.
Results: Seventeen (94%) patients had >50% PTH drop and in all patients cure was confirmed biochemically and histologically. All 17 patients had >50% drop in both S1 and S2. One patient had <50% drop and required further exploration but this failed to identify an adenoma and biochemistry confirmed absence of cure. All six patients with discordant scans had >50% drop and were cured.
Conclusion: In our initial experience iPTH had a high success rate in predicting successful surgical outcome, including in patients with discordant scans, reducing the need for wider exploration. It correctly indicated the need for further exploration in the patient with <50% PTH drop although it did not help the surgeon to identify the culprit gland and cure was not achieved. Use of two pre-excision samples may not be necessary although a larger study is needed to confirm this.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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