Radulova-Mauersberger Olga, Keßler Julia, Keßler Ulrich, Stange Katrin, Korn Sandra, Weitz Jürgen, Bork Ulrich
Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany.
Departments of Surgery and Endocrinology, Oberlausitz-Kliniken gGmbH and MVZ, 02625 Bautzen, Germany.
J Clin Med. 2022 Apr 4;11(7):2015. doi: 10.3390/jcm11072015.
Background: Cinacalcet is a calcimimetic drug that has increasingly been used as a bridging therapy for primary hyperparathyroidism (pHPT), especially during the COVID-19 pandemic. The aim of our study was to investigate if preoperative cinacalcet therapy affects intraoperative parathyroid hormone (IOPTH) monitoring during parathyroidectomy, which is an important indicator for the success of surgery. Methods: In this single-center retrospective analysis, we studied the outcomes of 72 patients who underwent surgery for pHPT. We evaluated two groups: those with cinacalcet therapy before operation—the cinacalcet group (CG)—and those without medical therapy preoperatively (non-CG). In order to perform a between-group comparison of time trends, we fit a linear mixed-effects model with PTH as the response variable and predictors PTH levels preoperatively, group (cinacalcet yes/no), time, the group-by-time interaction, and a random intercept (per subject). Results: Our cohort included 51 (71%) women and 21 (29%) men, who were operated upon for pHPT in the period from January 2018 until August 2021. All patients were diagnosed with pHPT and 54% of the cohort were symptomatic for hypercalcemia. Moreover, 30% of the patients were treated with cinacalcet as a bridging therapy preoperatively, and this increased during the COVID-19 pandemic, as 64% of this group were treated in the last two years. Calcium values were significantly different before (p < 0.001) and after (p = 0.0089) surgery, but calcium level change did not differ significantly between the CG and non-CG. Parathyroid hormone (PTH) levels dropped significantly in both groups during 10 min IOPTH monitoring (p < 0.001), but there was no significant difference between the two groups (p = 0.212). Conclusions: In the examined patient cohort, the use of cinacalcet did not affect the value of IOPTH monitoring during surgery for pHPT.
西那卡塞是一种拟钙剂药物，越来越多地被用作原发性甲状旁腺功能亢进症（pHPT）的过渡治疗药物，尤其是在新冠疫情期间。我们研究的目的是调查术前使用西那卡塞治疗是否会影响甲状旁腺切除术中的术中甲状旁腺激素（IOPTH）监测，这是手术成功的一项重要指标。方法：在这项单中心回顾性分析中，我们研究了72例接受pHPT手术患者的手术结果。我们评估了两组：术前接受西那卡塞治疗的患者——西那卡塞组（CG），以及术前未接受药物治疗的患者（非CG组）。为了进行组间时间趋势比较，我们拟合了一个线性混合效应模型，将PTH作为反应变量，预测变量包括术前PTH水平、组别（使用西那卡塞与否）、时间、组间时间交互作用以及一个随机截距（每个受试者）。结果：我们的队列包括51名（71%）女性和21名（29%）男性，他们在2018年1月至2021年8月期间接受了pHPT手术。所有患者均被诊断为pHPT，队列中54%的患者有高钙血症症状。此外，30%的患者术前接受西那卡塞作为过渡治疗，在新冠疫情期间这一比例有所增加，因为该组中64%的患者是在过去两年接受治疗的。手术前后钙值有显著差异（p < 0.001），但CG组和非CG组之间的钙水平变化无显著差异。在10分钟的IOPTH监测期间，两组的甲状旁腺激素（PTH）水平均显著下降（p < 0.001），但两组之间无显著差异（p = 0.212）。结论：在所研究的患者队列中，使用西那卡塞并不影响pHPT手术期间IOPTH监测的值。
