ECE2020 Oral Communications Bone and Calcium (7 abstracts)
Prediction algorithm for persistent primary hyperparathyroidism after parathyroidectomy
Andrea Repaci 1 , Valentina Vicennati 1 , Nicola Salituro 1 , Giulia Vandi 1 , Guido Zavatta 1 , Paola Altieri 1 , Guido Di Dalmazi 1 , Alessandra Gambineri 1 , Carla Pelusi 1 , Luca Burgio 2 , Ottavio Piccin 2 , Ottavio Cavicchi 2 & Uberto Pagotto 1
1Endocrinology and Prevention and Care of Diabetes Unit, S.Orsola Policlinic, Department of Medical and Surgical Sciences, Alma Mater University of Bologna, Bologna, Italy; 2Otolaryngology Head and Neck Surgery Unit, S. Orsola Policlinic, University of Bologna, Bologna, Bologna, Italy
Background: Primary hyperparathyroidism (PHPT) is characterized by an excessive secretion of the parathyroid hormone (PTH) with normal or high calcium levels. The gold standard therapy involves minimally invasive parathyroidectomy with intraoperative PTH (ioPTH) monitoring. Different criteria have been identified when predicting cure rates using ioPTH values.
Objective: To evaluate the percent ioPTH drop (ΔioPTH), the post-excision ioPTH, the first post-operative day PTH/calcium ratio and their possible combinations to predict persistent PHPT (PPHPT) after parathyroidectomy.
Methods: We retrospectively analyzed 211 patients who underwent parathyroidectomy with ioPTH for Primary hyperparathyroidism between 2008 and 2017 at the Department of Otolaryngology of S. Orsola Policlinic of Bologna. Vienna Criteria were used to evaluate the PTH drop during the procedure. By ROC curve we calculated ΔioPTH cut-off, the post-excision ioPTH cut-off, the first post-operative day PTH/calcium ratio cut-off. We compare these values with the Vienna Criteria.
Results: At the last follow-up, 16.4% of patients had normocalcemic PPHPT (NormoPPHPT) and 6% had hypercalcemic PPHPT (HyperPPHPT). ΔioPTH < 69.7% was associated with PPHPT with 66.7% sensitivity and 67.5% specificity. A post-excision ioPTH value ≥55 ng/ml was associated with PPHPT, with 80.0% sensitivity and 77.0% specificity. A first post-operative day PTH/calcium ratio ≥3.58 was associated with PPHPT, with 62.5% sensitivity and 79.8% specificity. PPHPT was more effectively identified with the combination of ΔioPTH < 69.7% and ioPTH post-excision ≥55 ng/ml than with the Vienna Criteria (Area under curve, AUC, 0.832 vs 0.620; P < 0.001). When added to the combination, the first post-operative day PTH/calcium ratio slightly but not significantly improved AUC (0.916; P = 0.187).
Conclusions: ΔioPTH < 69.7% and post-excision ioPTH ≥55 ng/ml combined are able to predict PPHPT and show a better accuracy than the Vienna Criteria. The combination can thus be a useful tool in post-surgical PHPT follow up.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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