Hyperparathyroidism other diagnostic studies
|
Hyperparathyroidism Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Hyperparathyroidism other diagnostic studies On the Web |
|
American Roentgen Ray Society Images of Hyperparathyroidism other diagnostic studies |
|
Risk calculators and risk factors for Hyperparathyroidism other diagnostic studies |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2]
Overview
- Other diagnostic study useful for preoperative localization of hyperfunctioning parathyroid glands include super selective venous sampling. Another diagnostic study include intraoperative parathyroid hormone monitoring (IOPTH). Measurement of intraoperative parathyroid hormone (IOPTH) by using a modified sensitive assay (immunoradiometric assay) is beneficial for predicting long term surgical outcomes.
Other Diagnostic Studies
Super Selective Venous Sampling
- Real-time super selective venous sampling (sSVS) is the most common invasive modality for preoperative localization of hyper-functioning parathyroid glands.[1]
- Real-time sSVS is a highly sensitive and specific technique used when traditional noninvasive imaging studies fail to localize hyper-functioning parathyroid glands preoperatively in patients with persistent or recurrent primary hyperparathyroidism.[2]
- Patients with a 2-fold gradient or more in cervical vein drainage locations (inferior, middle, and superior thyroid veins; thymic and vertebral veins) compared to the baseline value in the iliac vein are considered for exploration.[3]
Intraoperative parathyroid hormone (IOPTH)
- Measurement of intraoperative parathyroid hormone (IOPTH) by using a modified sensitive assay (immunoradiometric assay) is beneficial for predicting long term surgical outcomes.Post-surgical success is defined as postoperative normocalcemia.
- Patients with hyperparathyroidism due to lesion in a single gland shows a rapid decline of intact parathyroid hormone. The levels of intact parathyroid hormone reached to indetectable levels within hours of resection.[4]
- After resection of parathyroid adenoma, intact parathyroid hormone levels decrease by 85% is observed in first 15 minutes. This fall in parathyroid hormone levels is due to short half-life of parathyroid hormone.[5]
- The fall in parathyroid hormone level is significantly more after resection of parathyroid adenoma than after resection of parathyroid hyperplasia.
- A fall in level of parathyroid hormone 15 minutes after resection of hyper-functioning parathyroid glands may help differentiating sigle gland disease from multi gland disease.[6][7]
- IOPTH monitoring has a predictive accuracy of 97%. [8]
Technique for intraoperative parathyroid hormone (IOPTH) monitoring
- When the enlarged parathyroid gland is first visualized intraoperatively, the baseline sample should be obtained.[9]
- The baseline samples should never be obtained before induction of anesthesia. It is due to the fact that an increase in parathyroid hormone level may be observed after general anesthesia.
- After excision of enlarged gland, 2nd and 3rd samples are collected at 5 and 10 minutes respectively.
- Several criteria are used for predicting post-operative normocalcemia including:
- A decline in parathyroid hormone levels of ≥60% from baseline value at 15 minutes.
- A decline in parathyroid hormone levels of ≥50% from baseline value at 10 minutes.
References
- ↑ Lebastchi AH, Aruny JE, Donovan PI, Quinn CE, Callender GG, Carling T; et al. (2015). "Real-Time Super Selective Venous Sampling in Remedial Parathyroid Surgery". J Am Coll Surg. 220 (6): 994–1000. doi:10.1016/j.jamcollsurg.2015.01.004. PMID 25868412.
- ↑ Sugg SL, Fraker DL, Alexander R, Doppman JL, Miller DL, Chang R; et al. (1993). "Prospective evaluation of selective venous sampling for parathyroid hormone concentration in patients undergoing reoperations for primary hyperparathyroidism". Surgery. 114 (6): 1004–9, discussion 1009-10. PMID 8256203.
- ↑ Powell AC, Alexander HR, Chang R, Marx SJ, Skarulis M, Pingpank JF; et al. (2009). "Reoperation for parathyroid adenoma: a contemporary experience". Surgery. 146 (6): 1144–55. doi:10.1016/j.surg.2009.09.015. PMC 3467310. PMID 19958942.
- ↑ Nussbaum SR, Thompson AR, Hutcheson KA, Gaz RD, Wang CA (1988). "Intraoperative measurement of parathyroid hormone in the surgical management of hyperparathyroidism". Surgery. 104 (6): 1121–7. PMID 3194839.
- ↑ Bergenfelz A, Isaksson A, Ahrén B (1994). "Intraoperative monitoring of intact PTH during surgery for primary hyperparathyroidism". Langenbecks Arch Chir. 379 (1): 50–3. PMID 8145618.
- ↑ Irvin III, George L.; Dembrow, Victor D.; Prudhomme, David L. (December 1993). "Clinical usefulness of an intraoperative "quick parathyroid hormone" assay". Surgery. 114 (6): 1019–1023.
- ↑ Bergenfelz A, Isaksson A, Lindblom P, Westerdahl J, Tibblin S (1998). "Measurement of parathyroid hormone in patients with primary hyperparathyroidism undergoing first and reoperative surgery". Br J Surg. 85 (8): 1129–32. doi:10.1046/j.1365-2168.1998.00824.x. PMID 9718013.
- ↑ Boggs JE, Irvin GL, Molinari AS, Deriso GT (1996). "Intraoperative parathyroid hormone monitoring as an adjunct to parathyroidectomy" (PDF). Surgery. 120 (6): 954–8. doi:10.1016/S0039-6060(96)80040-7. PMID 8957480.
- ↑ Westerdahl J, Lindblom P, Bergenfelz A (2002). "Measurement of intraoperative parathyroid hormone predicts long-term operative success". Arch Surg. 137 (2): 186–90. doi:10.1001/archsurg.137.2.186. PMID 11822958.