Kinetic analysis of the rapid intraoperative parathyroid hormone assay in patients during operation for hyperparathyroidism

Background: Rapid intraoperative parathyroid hormone (RI-PTH) assay is used to guide adequacy of resection during operation for hyperparathyroidism. We compared the RI-PTH assay (15 minutes) with a standard PTH assay, determined whether the PTH half-life varied between patients, and constructed a ki...

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Bibliographic Details
Published in:Surgery 1999-12, Vol.126 (6), p.1145-1151
Main Authors: Libutti, Steven K., Alexander, H.Richard, Bartlett, David L., Sampson, Maureen L., Ruddel, Mark E., Skarulis, Monica, Marx, Stephen J., Spiegel, Allen M., Simmonds, William, Remaley, Alan T.
Format: Article
Language:English
Subjects:
Adult
Algorithms
Chemistry, Clinical - methods
Chemistry, Clinical - standards
False Negative Reactions
False Positive Reactions
Female
Humans
Hyperparathyroidism - blood
Hyperparathyroidism - surgery
Immunoassay
Intraoperative Period
Kinetics
Luminescent Measurements
Male
Middle Aged
Parathyroid Hormone - blood
Parathyroidectomy
Reference Values
Time Factors
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Summary:Background: Rapid intraoperative parathyroid hormone (RI-PTH) assay is used to guide adequacy of resection during operation for hyperparathyroidism. We compared the RI-PTH assay (15 minutes) with a standard PTH assay, determined whether the PTH half-life varied between patients, and constructed a kinetic analysis of the RI-PTH data. Methods: Forty-five patients with hyperparathyroidism had blood sampled at baseline and at times after parathyroid resection. Intact PTH was determined using RI-PTH and a standard assay. Values were fitted to an exponential decay curve using the baseline and the follow-up time points. PTH half-life and the new postexcision baseline value were calculated from the decay curve. Results: The RI-PTH assay and the standard PTH assay correlated well. Average PTH half-life was 1.68 ± 0.94 minutes (0.42 to 3.81 minutes). A kinetic analysis yielded a formula for the generation of a PTH decay curve. Using a 50% reduction in RI-PTH at 5 minutes as the criterion for adequate resection, 2 patients were incorrectly classified as not being cured. These patients were correctly classified using the kinetic analysis. Conclusions: PTH half-life can vary substantially. A kinetic analysis may be more accurate in assessing adequacy of resection. This method allows the surgeon to interpret RI-PTH data independent of the timing of samples. (Surgery 1999;126:1145-51.)
ISSN:0039-6060
1532-7361
DOI:10.1067/msy.2099.101835