Endocrine Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Drive, MSC1201 Room 3-3940, Bethesda, MD 20892-1201, USA.
World J Surg. 2013 Aug;37(8):1966-72. doi: 10.1007/s00268-013-2054-1.
Intraoperative parathyroid hormone monitoring (IOPTH) is a widely used adjunct for primary hyperparathyroidism (pHPT). However, the benefit of IOPTH in familial pHPT, such as in multiple endocrine neoplasia type I (MEN1), remains unclear.
We performed a retrospective analysis of 52 patients with MEN1-associated pHPT undergoing initial parathyroidectomy with IOPTH monitoring at our institution. Parathyroid hormone (PTH) levels were measured before skin incision and 10 min after resection of the last parathyroid gland. Variables analyzed included percent drop of PTH from baseline and the final PTH level compared to the normal reference range (RR).
A total of 52 patients underwent initial subtotal parathyroidectomy with IOPTH. An IOPTH decrease cutoff of ≥75 % from baseline had the highest biochemical cure rate (87 %). In the remaining 13 % who met this cutoff, all had persistent pHPT, with ≥90 % drop of PTH from baseline. The remaining patients, who did not meet the ≥75 % cutoff, were cured. Follow-up was available for three of four patients with final IOPTH levels above the RR: one had persistent pHPT, two had hypoparathyroidism (50 %). When a postresection PTH level was within the RR, 88 % of patients were cured. While considered cured from pHPT, 7 % of patients in this group developed permanent hypoparathyroidism. When the final PTH level dropped below the RR, 28 % developed permanent hypoparathyroidism.
A cutoff in IOPTH decrease of ≥75 % from baseline has the highest biochemically cure rate in patients with pHPT associated with MEN1. However, a 75 % cutoff in IOPTH decrease does not exclude persistent pHPT. The absolute IOPTH value does not accurately predict postoperative hypoparathyroidism.
术中甲状旁腺激素监测（IOPTH）是原发性甲状旁腺功能亢进症（pHPT）的一种广泛应用的辅助手段。然而，在多发性内分泌腺瘤病 1 型（MEN1）等家族性 pHPT 中，IOPTH 的益处仍不清楚。
我们对在我院行初始甲状旁腺切除术并接受 IOPTH 监测的 52 例 MEN1 相关 pHPT 患者进行了回顾性分析。在切开皮肤前和最后一个甲状旁腺切除后 10 分钟测量甲状旁腺激素（PTH）水平。分析的变量包括与基线相比 PTH 的下降百分比和最后 PTH 水平与正常参考范围（RR）的比较。
共有 52 例患者接受了初始次全甲状旁腺切除术和 IOPTH。从基线下降≥75%的 IOPTH 下降截断值具有最高的生化治愈率（87%）。在其余 13%未达到该截断值的患者中，所有患者均存在持续性 pHPT，基线 PTH 下降≥90%。其余未达到≥75%截断值的患者均被治愈。4 例患者中有 3 例获得了最后 IOPTH 水平高于 RR 的随访结果：1 例持续存在 pHPT，2 例存在甲状旁腺功能减退（50%）。当术后 PTH 水平在 RR 范围内时，88%的患者被治愈。虽然从 pHPT 方面被认为治愈，但该组中有 7%的患者发生永久性甲状旁腺功能减退。当最后 PTH 水平降至 RR 以下时，28%的患者发生永久性甲状旁腺功能减退。
在与 MEN1 相关的 pHPT 患者中，从基线下降≥75%的 IOPTH 下降截断值具有最高的生化治愈率。然而，IOPTH 下降的 75%截断值并不能排除持续性 pHPT。绝对的 IOPTH 值不能准确预测术后甲状旁腺功能减退症。
