Utility of rapid intraoperative parathyroid hormone assay to predict severe postoperative hypocalcemia after reoperation for hyperparathyroidism

Dina M. Elaraj, Alan T. Remaley, William F. Simonds, Monica C. Skarulis, Steven K. Libutti, David L. Bartlett, David J. Venzon, Stephen J. Marx, H. Richard Alexander, Ashok Shaha, Christopher McHenry, Irving B. Rosen, Bruno Niederle, Gerhard Prager, Edwin Kaplan, Paulo LoGerfo

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background. Patients undergoing reoperative parathyroidectomy may develop severe transient or permanent hypoparathyroidism. This study's purpose was to determine the utility of intraoperative parathyroid hormone (IO-PTH) values in predicting the development of severe hypocalcemia for patients undergoing reoperation for primary hyperparathyroidism. Methods. Between March 1999 and October 2001, 68 patients with persistent or recurrent hyperparathyroidism underwent reoperation using IO-PTH measurements. The maximum percent decrease and lowest actual PTH value obtained at surgery were compared to determine any correlation with the development of postoperative hypocalcemia requiring supplementation. Results. Of 68 patients, 25 required calcium and calcitriol postoperatively and 43 did not. There was a significant difference between the 2 groups with respect to lowest IO-PTH value (18. 4 ± 2.6 vs 28.0 ± 3.9 pg/mL; P = .02), percent decrease in IO-PTH (89% ± 1% vs 80% ± 3%; P = .03), and lowest postoperative ionized calcium (1.06 ± 0.01 vs 1.19 ± 0.01 mmol/L; P < .001). A percent decrease in IO-PTH of 84 % or greater was found to be predictive of patients experiencing hypocalcemia requiring supplementation with a positive predictive value of 46% and a negative predictive value of 82%. Conclusions. Although a maximum percent decrease in IO-PTH of 84% or greater was associated with an increased incidence of postoperative hypocalcemia requiring supplementation in the 68-patient cohort, on further analysis the association was significant only for patients with multiglandular disease and not those with single adenomas. This value may be useful for identifying patients who will need closer postoperative monitoring or prophylactic supplementation.

Original languageEnglish (US)
Pages (from-to)1028-1034
Number of pages7
JournalSurgery
Volume132
Issue number6
DOIs
StatePublished - Dec 1 2002
Externally publishedYes

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Hypocalcemia
Hyperparathyroidism
Parathyroid Hormone
Reoperation
Calcium
Hypoparathyroidism
Parathyroidectomy
Primary Hyperparathyroidism
Calcitriol
Adenoma
Incidence

ASJC Scopus subject areas

  • Surgery

Cite this

Elaraj, D. M., Remaley, A. T., Simonds, W. F., Skarulis, M. C., Libutti, S. K., Bartlett, D. L., ... LoGerfo, P. (2002). Utility of rapid intraoperative parathyroid hormone assay to predict severe postoperative hypocalcemia after reoperation for hyperparathyroidism. Surgery, 132(6), 1028-1034. https://doi.org/10.1067/msy.2002.128480

Utility of rapid intraoperative parathyroid hormone assay to predict severe postoperative hypocalcemia after reoperation for hyperparathyroidism. / Elaraj, Dina M.; Remaley, Alan T.; Simonds, William F.; Skarulis, Monica C.; Libutti, Steven K.; Bartlett, David L.; Venzon, David J.; Marx, Stephen J.; Alexander, H. Richard; Shaha, Ashok; McHenry, Christopher; Rosen, Irving B.; Niederle, Bruno; Prager, Gerhard; Kaplan, Edwin; LoGerfo, Paulo.

In: Surgery, Vol. 132, No. 6, 01.12.2002, p. 1028-1034.

Research output: Contribution to journalArticle

Elaraj, DM, Remaley, AT, Simonds, WF, Skarulis, MC, Libutti, SK, Bartlett, DL, Venzon, DJ, Marx, SJ, Alexander, HR, Shaha, A, McHenry, C, Rosen, IB, Niederle, B, Prager, G, Kaplan, E & LoGerfo, P 2002, 'Utility of rapid intraoperative parathyroid hormone assay to predict severe postoperative hypocalcemia after reoperation for hyperparathyroidism', Surgery, vol. 132, no. 6, pp. 1028-1034. https://doi.org/10.1067/msy.2002.128480
Elaraj, Dina M. ; Remaley, Alan T. ; Simonds, William F. ; Skarulis, Monica C. ; Libutti, Steven K. ; Bartlett, David L. ; Venzon, David J. ; Marx, Stephen J. ; Alexander, H. Richard ; Shaha, Ashok ; McHenry, Christopher ; Rosen, Irving B. ; Niederle, Bruno ; Prager, Gerhard ; Kaplan, Edwin ; LoGerfo, Paulo. / Utility of rapid intraoperative parathyroid hormone assay to predict severe postoperative hypocalcemia after reoperation for hyperparathyroidism. In: Surgery. 2002 ; Vol. 132, No. 6. pp. 1028-1034.
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title = "Utility of rapid intraoperative parathyroid hormone assay to predict severe postoperative hypocalcemia after reoperation for hyperparathyroidism",
abstract = "Background. Patients undergoing reoperative parathyroidectomy may develop severe transient or permanent hypoparathyroidism. This study's purpose was to determine the utility of intraoperative parathyroid hormone (IO-PTH) values in predicting the development of severe hypocalcemia for patients undergoing reoperation for primary hyperparathyroidism. Methods. Between March 1999 and October 2001, 68 patients with persistent or recurrent hyperparathyroidism underwent reoperation using IO-PTH measurements. The maximum percent decrease and lowest actual PTH value obtained at surgery were compared to determine any correlation with the development of postoperative hypocalcemia requiring supplementation. Results. Of 68 patients, 25 required calcium and calcitriol postoperatively and 43 did not. There was a significant difference between the 2 groups with respect to lowest IO-PTH value (18. 4 ± 2.6 vs 28.0 ± 3.9 pg/mL; P = .02), percent decrease in IO-PTH (89{\%} ± 1{\%} vs 80{\%} ± 3{\%}; P = .03), and lowest postoperative ionized calcium (1.06 ± 0.01 vs 1.19 ± 0.01 mmol/L; P < .001). A percent decrease in IO-PTH of 84 {\%} or greater was found to be predictive of patients experiencing hypocalcemia requiring supplementation with a positive predictive value of 46{\%} and a negative predictive value of 82{\%}. Conclusions. Although a maximum percent decrease in IO-PTH of 84{\%} or greater was associated with an increased incidence of postoperative hypocalcemia requiring supplementation in the 68-patient cohort, on further analysis the association was significant only for patients with multiglandular disease and not those with single adenomas. This value may be useful for identifying patients who will need closer postoperative monitoring or prophylactic supplementation.",
author = "Elaraj, {Dina M.} and Remaley, {Alan T.} and Simonds, {William F.} and Skarulis, {Monica C.} and Libutti, {Steven K.} and Bartlett, {David L.} and Venzon, {David J.} and Marx, {Stephen J.} and Alexander, {H. Richard} and Ashok Shaha and Christopher McHenry and Rosen, {Irving B.} and Bruno Niederle and Gerhard Prager and Edwin Kaplan and Paulo LoGerfo",
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T1 - Utility of rapid intraoperative parathyroid hormone assay to predict severe postoperative hypocalcemia after reoperation for hyperparathyroidism

AU - Elaraj, Dina M.

AU - Remaley, Alan T.

AU - Simonds, William F.

AU - Skarulis, Monica C.

AU - Libutti, Steven K.

AU - Bartlett, David L.

AU - Venzon, David J.

AU - Marx, Stephen J.

AU - Alexander, H. Richard

AU - Shaha, Ashok

AU - McHenry, Christopher

AU - Rosen, Irving B.

AU - Niederle, Bruno

AU - Prager, Gerhard

AU - Kaplan, Edwin

AU - LoGerfo, Paulo

PY - 2002/12/1

Y1 - 2002/12/1

N2 - Background. Patients undergoing reoperative parathyroidectomy may develop severe transient or permanent hypoparathyroidism. This study's purpose was to determine the utility of intraoperative parathyroid hormone (IO-PTH) values in predicting the development of severe hypocalcemia for patients undergoing reoperation for primary hyperparathyroidism. Methods. Between March 1999 and October 2001, 68 patients with persistent or recurrent hyperparathyroidism underwent reoperation using IO-PTH measurements. The maximum percent decrease and lowest actual PTH value obtained at surgery were compared to determine any correlation with the development of postoperative hypocalcemia requiring supplementation. Results. Of 68 patients, 25 required calcium and calcitriol postoperatively and 43 did not. There was a significant difference between the 2 groups with respect to lowest IO-PTH value (18. 4 ± 2.6 vs 28.0 ± 3.9 pg/mL; P = .02), percent decrease in IO-PTH (89% ± 1% vs 80% ± 3%; P = .03), and lowest postoperative ionized calcium (1.06 ± 0.01 vs 1.19 ± 0.01 mmol/L; P < .001). A percent decrease in IO-PTH of 84 % or greater was found to be predictive of patients experiencing hypocalcemia requiring supplementation with a positive predictive value of 46% and a negative predictive value of 82%. Conclusions. Although a maximum percent decrease in IO-PTH of 84% or greater was associated with an increased incidence of postoperative hypocalcemia requiring supplementation in the 68-patient cohort, on further analysis the association was significant only for patients with multiglandular disease and not those with single adenomas. This value may be useful for identifying patients who will need closer postoperative monitoring or prophylactic supplementation.

AB - Background. Patients undergoing reoperative parathyroidectomy may develop severe transient or permanent hypoparathyroidism. This study's purpose was to determine the utility of intraoperative parathyroid hormone (IO-PTH) values in predicting the development of severe hypocalcemia for patients undergoing reoperation for primary hyperparathyroidism. Methods. Between March 1999 and October 2001, 68 patients with persistent or recurrent hyperparathyroidism underwent reoperation using IO-PTH measurements. The maximum percent decrease and lowest actual PTH value obtained at surgery were compared to determine any correlation with the development of postoperative hypocalcemia requiring supplementation. Results. Of 68 patients, 25 required calcium and calcitriol postoperatively and 43 did not. There was a significant difference between the 2 groups with respect to lowest IO-PTH value (18. 4 ± 2.6 vs 28.0 ± 3.9 pg/mL; P = .02), percent decrease in IO-PTH (89% ± 1% vs 80% ± 3%; P = .03), and lowest postoperative ionized calcium (1.06 ± 0.01 vs 1.19 ± 0.01 mmol/L; P < .001). A percent decrease in IO-PTH of 84 % or greater was found to be predictive of patients experiencing hypocalcemia requiring supplementation with a positive predictive value of 46% and a negative predictive value of 82%. Conclusions. Although a maximum percent decrease in IO-PTH of 84% or greater was associated with an increased incidence of postoperative hypocalcemia requiring supplementation in the 68-patient cohort, on further analysis the association was significant only for patients with multiglandular disease and not those with single adenomas. This value may be useful for identifying patients who will need closer postoperative monitoring or prophylactic supplementation.

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