Kinetic analysis of the rapid intraoperative parathyroid hormone assay in patients during operation for hyperparathyroidism

Steven K. Libutti, H. Richard Alexander, David L. Bartlett, Maureen L. Sampson, Mark E. Ruddel, Monica Skarulis, Stephen J. Marx, Allen M. Spiegel, William Simmonds, Alan T. Remaley

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Abstract

Background. Rapid intraoperative parathyroid hormone (RI-PTH) assay is used to guide adequacy of resection during operation for hyperparathyroidism. We compared the RI-PTH assay (15 minutes) with a standard PTH assay, determined whether the PTH half-life varied between patients, and constructed a kinetic analysis of the RI-PTH data. Methods. Forty-five patients with hyperparathyroidism had blood sampled at baseline and at times after parathyroid resection. Intact PTH was determined using RI-PTH and a standard assay. Values were fitted to an exponential decay curve using the baseline and the follow-up time points. PTH half-life and the new postexcision baseline value were calculated from the decay curve. Results. The RI-PTH assay and the standard PTH assay correlated well. Average PTH half-life was 1.68 ± 0.94 minutes (0.42 to 3.81 minutes). A kinetic analysis yielded a formula for the generation of a PTH decay curve. Using a 50% reduction in RI- PTH at 5 minutes as the criterion for adequate resection, 2 patients were incorrectly classified as not being cured. These patients were correctly classified using the kinetic analysis. Conclusions. PTH half-life can vary substantially. A kinetic analysis may be more accurate in assessing adequacy of resection. This method allows the surgeon to interpret RI-PTH data independent of the timing of samples.

Original languageEnglish (US)
Pages (from-to)1145-1151
Number of pages7
JournalSurgery
Volume126
Issue number6
DOIs
Publication statusPublished - Jan 1 1999

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ASJC Scopus subject areas

  • Surgery

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Libutti, S. K., Alexander, H. R., Bartlett, D. L., Sampson, M. L., Ruddel, M. E., Skarulis, M., ... Remaley, A. T. (1999). Kinetic analysis of the rapid intraoperative parathyroid hormone assay in patients during operation for hyperparathyroidism. Surgery, 126(6), 1145-1151. https://doi.org/10.1067/msy.2099.101835