Faculty Collaboration Database

Biochemical Profile Affects IOPTH Kinetics and Cure Rate in Primary Hyperparathyroidism. World J Surg 2020 Feb;44(2):488-495

Date

09/13/2019

Pubmed ID

31511943

DOI

10.1007/s00268-019-05157-x

Scopus ID

2-s2.0-85072103650 (requires institutional sign-in at Scopus site)   20 Citations

Abstract

BACKGROUND: Recently, normocalcemic (NC) and normohormonal (NH) variants of primary hyperparathyroidism (pHPT) have been described, with distinct biochemical profiles from the typical high serum calcium and parathyroid hormone (PTH) levels. Here, we investigate whether biochemical profile affects cure rate, as well as the kinetics of intraoperative PTH (IOPTH).

METHODS: This is a single-center, retrospective study of pHPT patients undergoing parathyroidectomy. Patients were grouped based on preoperative calcium and PTH levels into typical, NC (normal calcium, elevated PTH, no evidence of secondary hyperparathyroidism), and NH (elevated calcium, unsuppressed PTH) biochemical profiles. All patients had IOPTH monitoring and ≥6-month post-op serum studies to confirm surgical cure. Patient variables were analyzed with Kruskal-Wallis test and Chi-square analysis. IOPTH kinetic curves were analyzed using a linear mixed model.

RESULTS: From June 2006 to October 2014, 646 patients met inclusion criteria. Biochemical profile was typical in 460 patients (71%), NC in 101 (16%), and NH in 85 (13%). IOPTH levels were higher at all time points in typical patients, p < 0.001. Surgical cure rates were significantly lower for NC patients (90.1%) than for typical (98.5%) or NH patients (97.7%), p < 0.001, although a stricter criteria for cure was used in this group (normal calcium AND normal PTH). In a multivariable linear mixed model, NC patients had a significantly slower rate of IOPTH decline (p < 0.001 at 10 min).

CONCLUSIONS: Here, we better characterize the atypical variants of pHPT. Using a stricter definition of cure in the NC variant, these patients have a lower surgical cure rate than typical or NH variants in pHPT. The IOPTH curve is affected by biochemical profile, with both NC and NH patients having lower absolute values and NC patients having a slower decline.

Author List

Graves CE, McManus CM, Chabot JA, Lee JA, Kuo JH

Author

Catherine McManus MD, MS Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Calcium
Female
Humans
Hyperparathyroidism, Primary
Kinetics
Male
Middle Aged
Monitoring, Intraoperative
Parathyroid Hormone
Parathyroidectomy
Retrospective Studies