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Biochemical Profile Affects IOPTH Kinetics and Cure Rate in Primary Hyperparathyroidism

  • Claire E. Graves
  • Catherine M. McManus
  • John A. Chabot
  • James A. Lee
  • Jennifer H. KuoEmail author
Original Scientific Report
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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.

Notes

Authors’ contributions

CG contributed to data acquisition, analysis and interpretation of data, and drafting of the manuscript; CM contributed to acquisition of data and critical revisions; JC and JL performed critical revisions; JK contributed to study conception and design, analysis and interpretation of data, and drafting of the manuscript.

Compliance with ethical standards

Conflicts of interest

The authors declare they have no proprietary or commercial interest in any product mentioned or concept discussed in this article.

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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Claire E. Graves
    • 1
  • Catherine M. McManus
    • 1
  • John A. Chabot
    • 1
  • James A. Lee
    • 1
  • Jennifer H. Kuo
    • 1
    Email author
  1. 1.Department of SurgeryColumbia University Medical CenterNew YorkUSA

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