Endocrine Surgery Unit, Hospital del Mar, Barcelona, Spain.
World J Surg. 2010 Jun;34(6):1337-42. doi: 10.1007/s00268-010-0413-8.
Some patients with double parathyroid adenoma show a greater than 50% decline in intraoperative parathyroid hormone (IOPTH) after resection of the first lesion. The present study was designed to test the hypothesis that significant adenoma weight differences may explain this inappropriate decline of IOPTH.
We reviewed prospective database records at two tertiary institutions. Patients with a histopathologic diagnosis of double adenoma and no familial history of hyperparathyroidism were included. Diagnosis of double adenoma was confirmed either preoperatively (double uptake), intraoperatively (bilateral exploration), or at reintervention. IOPTH was determined following the Miami protocol. The 10-min postexcision sample was considered as the 0-min sample for IOPTH determinations at the time of resection of the second lesion.
Thirteen patients met the inclusion criteria. After resection of the first lesion, IOPTH failed to decline in four patients and a second adenoma was removed. They had similar weight (404 vs. 598 mg). In nine patients IOPTH showed a false greater than 50% decline. These patients had the largest adenoma removed first (846 +/- 226 mg), and only two had normal PTH serum concentrations 10 min after resection. The second adenoma was always smaller (284 +/- 177 mg; P = 0.02) and its resection either during the same operation (7 cases) or at reoperation (2 cases) led to normalization of IOPTH at 10 min in all cases.
Two-thirds of patients with double parathyroid adenoma show a false-positive decline of IOPTH after resection of the first adenoma. This appears to be due to the initial removal of the larger lesion.
一些患有双侧甲状旁腺腺瘤的患者，在切除第一个病变后，其术中甲状旁腺激素（IOPTH）下降超过 50%。本研究旨在验证这样一个假设，即显著的腺瘤重量差异可能解释 IOPTH 这种不适当的下降。
我们回顾了两个三级医疗机构的前瞻性数据库记录。纳入具有双腺瘤组织病理学诊断且无家族性甲状旁腺功能亢进病史的患者。双腺瘤的诊断通过术前（双摄取）、术中（双侧探查）或再次干预来确认。采用迈阿密方案测定 IOPTH。第二次病变切除时，将 10 分钟切除后样本视为 0 分钟 IOPTH 测定的 0 分钟样本。
13 名患者符合纳入标准。在切除第一个病变后，有 4 名患者的 IOPTH 没有下降，并且切除了第二个腺瘤。它们的重量相似（404 与 598 毫克）。在 9 名患者中，IOPTH 显示出错误的大于 50%的下降。这些患者首先切除了最大的腺瘤（846 +/- 226 毫克），只有 2 名患者在切除后 10 分钟血清 PTH 浓度正常。第二个腺瘤总是较小（284 +/- 177 毫克；P = 0.02），并且在同一手术中（7 例）或再次手术中（2 例）切除，所有患者在 10 分钟时 IOPTH 均恢复正常。
三分之二的双侧甲状旁腺腺瘤患者在切除第一个腺瘤后，其 IOPTH 表现出假阳性下降。这似乎是由于最初切除了较大的病变。
