scholarly journals Application of Tissue Aspirate Parathyroid Hormone Assay for Imaging Suspicious Neck Lesions in Patients with Complicated Recurrent or Persistent Renal Hyperparathyroidism

2021 ◽  
Vol 10 (2) ◽  
pp. 329
Author(s):  
Chien-Ling Hung ◽  
Yu-Chen Hsu ◽  
Shih-Ming Huang ◽  
Chung-Jye Hung
Keyword(s):  
Parathyroid Hormone ◽  
Final Diagnosis ◽  
Imaging Studies ◽  
Renal Hyperparathyroidism ◽  
Operative Surgery ◽  
Parathyroid Hormone Assay ◽  
Serum Pth ◽  
Pth Level ◽  
Suspicious Lesions

Background: Comprehensive pre-reoperative localization is essential in complicated persistent or recurrent renal hyperparathyroidism. The widely used imaging studies sometimes lead to ambiguous results. Our study aimed to clarify the role of tissue aspirate parathyroid hormone (PTH) assay with a new positive assay definition for imaging suspicious neck lesions in these challenging scenarios. Methods: All patients with complicated recurrent or persistent renal hyperparathyroidism underwent parathyroid sonography and scintigraphy. Echo-guided tissue aspirate PTH assay was performed in suspicious lesions revealed by localization imaging studies. The tissue aspirate PTH level was determined by an immunoradiometric assay. We proposed a newly-developed definition for positive assay as a washout level higher than one-thirtieth of the serum PTH level obtained at the same time. The final diagnosis after re-operation was confirmed by the pathologists. Results: In total, 50 tissue aspirate PTH assays were performed in 32 patients with imaging suspicious neck lesions, including discrepant results between scintigraphy and sonography in 47 lesions (94%), unusual locations in 19 lesions (38%), multiple foci in 28 lesions (56%), and locations over previously explored areas in 31 lesions (62%). Among 39 assay-positive lesions, 13 lesions (33.3%) were not identified by parathyroid scintigraphy, and 28 lesions (71.8%) had uncertain parathyroid sonography findings. The final pathology in patients who underwent re-operative surgery proved the tissue aspirate PTH assays had a 100% positive predictive value. Conclusions: Our findings suggest tissue aspirate PTH assay with this new positive assay definition is beneficial to clarify the nature of imaging suspicious lesions in patients with complicated persistent or recurrent renal hyperparathyroidism.

A Successful Application of the Intraoperative Parathyroid Hormone Assay in Tertiary Hyperparathyroidism

2007 ◽  
Vol 73 (3) ◽  
pp. 281-283 ◽  
Author(s):  
Leila Thanasoulis ◽  
Juliane Bingener ◽  
Kenneth Sirinek ◽  
Melanie Richards
Keyword(s):  
Parathyroid Hormone ◽  
Success Rates ◽  
Tertiary Hyperparathyroidism ◽  
Equivalent Rate ◽  
Parathyroid Hormone Assay ◽  
The Mean ◽  
Intraoperative Parathyroid Hormone ◽  
Intraoperative Parathyroid Hormone Assay

The role of the intraoperative parathyroid hormone (IOPTH) assay in patients with tertiary hyperparathyroidism (3HPT) is not well defined. To evaluate the utility of the IOPTH in 3HPT, we compared its use in 72 patients with primary hyperparathyroidism (1HPT) and 3HPT undergoing parathyroidectomy. Sixty-three patients with 1HPT and nine patients with 3HPT were identified. There were 30 men and 42 women (mean age, 58 years). The mean serum calcium and preoperative intact PTH levels in 1HPT were 11.1 mg/dL and 214 pg/mL compared with 11.2 mg/dL and 849 pg/mL in 3HPT (Ca, non significant; PTH, P < 0.05). Intraoperatively, a solitary abnormal gland was found in 62 of 72 (86%) patients. Seven patients with 3HPT had three- or four-gland hyperplasia. The two groups were compared to determine if a 10-minute postexcision IOPTH decline >50 per cent would have similar success rates. Seventy-one of 72 (98.6%) patients had a >50 per cent decline from the baseline IOPTH at the end of the operation. The average reduction from baseline was 85.3 per cent in 1HPT and 88.6 per cent in 3HPT (not significant). Average follow-up was 9.8 months for 1HPT and 11.1 months in 3HPT. Three of 63 patients (4.8%) with 1HPT and five of nine patients (55.6%) with 3HPT had inappropriate elevations in PTH ( P < 0.05). All patients with 3HPT were normocalcemic compared with 62 of 64 (97%) patients with 1HPT (not significant). The IOPTH assay can be used in 3HPT in an identical fashion with an equivalent rate of normocalcemia compared with its applications in 1HPT.

Role of uremia, brain calcium, and parathyroid hormone on changes in electroencephalogram in chronic renal failure

1984 ◽  
Vol 246 (5) ◽  
pp. F575-F579
Author(s):  
M. Akmal ◽  
D. A. Goldstein ◽  
S. Multani ◽  
S. G. Massry
Keyword(s):  
Renal Failure ◽  
Parathyroid Hormone ◽  
Chronic Renal Failure ◽  
White Matter ◽  
Blood Levels ◽  
Marked Rise ◽  
Per Se ◽  
Serum Pth ◽  
Electroencephalogram Eeg

Acute uremia is associated with increased calcium (Ca) in brain and changes in electroencephalogram (EEG), and both derangements are related to excess parathyroid hormone (PTH). Also changes in EEG in patients with chronic renal failure (CRF) correlated directly with blood levels of PTH, and fall in PTH was followed by improvement in EEG. We examined whether chronic uremia per se has an effect on brain calcium or EEG. Uremia was produced by 5/6 nephrectomy and maintained for 32-70 wk in seven thyroparathyroidectomized (TPTX) and seven control dogs. There were no differences in creatinine clearance and serum electrolytes except for HCO3, which was lower in control animals (P less than 0.01). Serum PTH was undetectable in TPTX dogs but was significantly elevated in control animals (32.3 +/- 3.3 mu leq /ml). Calcium in gray and white matter was significantly increased in both groups but much higher in control animals. The percent waves of less than 7 Hz in EEG were similar in both groups prior to uremia (TPTX 4.6 +/- 0.8 vs. control 4.2 +/- 0.5%) but remained unchanged in TPTX animals and increased significantly in control dogs (19.0 +/- 1.3%) after uremia. These data suggest that CRF per se is associated with marked rise in Ca in both gray and white matter and increment is higher in the presence of PTH. Disturbance in EEG in a state of CRF requires the presence of excess PTH and is prevented despite increased Ca in brain if hyperparathyroidism is not allowed to develop.

scholarly journals Relationship between Parathyroid Hormone Level and Early Remodeling Heart Failure after Acute Myocardial Infarction

2020 ◽  
Author(s):  
Zohreh Firouzi ◽  
Saeideh Mahdizadeh Sajjadieh ◽  
Saeideh Mahdizadeh Sajjadieh ◽  
Maryam Mousavi ◽  
Zahra Erfanian ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Vitamin D ◽  
Parathyroid Hormone ◽  
Serum Vitamin ◽  
Current Evidence ◽  
Serum Vitamin D ◽  
Serum Pth ◽  
Pth Level

Background: Previous studies have indicated that parathyroid hormone (PTH) has been linked to post-myocardial infarction (MI) development. The aim of this cross-sectional study was to evaluate the relationship between PTH level and heart failure due to post infarction remodeling during the first 72 hours of hospitalization. Methods: Seventy patients with a diagnosis of acute MI (age ≥18 years, 22 females and 48 males) were enrolled. Patients were admitted to the Imam Raza Educational, Research and Treatment Center, Mashhad University of Medical Sciences, Iran between July 2014 to September 2015. We measured PTH and vitamin D level. Blood samples were taken after 24 hours and 72 hours. Results: During the first 72 hours, the PTH level significantly increased in patients with Post-MI heart failure. 68% of the subjects had an inappropriate vitamin D level at the time of admission. Mean levels of vitamin D and PTH increased compared with the baselines (95% CI, 0.15 to 10.03, P: 0.044), (95% CI, 6.5 to 24.8, P:0.001) respectively. Conclusion: Acute elevations of serum PTH levels increased early remodeling heart failure after MI. Serum vitamin D status was independent of high serum PTH level. Based on the current evidence, PTH excess may be a risk factor for heart failure, so early treatment and omitting risk factors are the most effective strategies for the patients with acute myocardial infarction. J Pharm Care 2020; 8(1): 11-15.

scholarly journals Resolution of primary hyperparathyroidism following surgical removal of cervical thymus

2017 ◽  
Vol 4 (2) ◽  
pp. 5
Author(s):  
Rossella Cannarella ◽  
Beniamino Scilletta ◽  
Roberto Scilletta ◽  
Gaetano Magro ◽  
Aldo E. Calogero
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Single Case ◽  
Thymic Epithelial Cells ◽  
Surgical Removal ◽  
Thymus Tissue ◽  
Medullary Thymic Epithelial Cells ◽  
Serum Pth ◽  
Thymus Cells

Recent research has emphasized the capacity of thymus cells of producing parathyroid hormone (PTH) if adequately stimulated, and have investigated the role of the so-called “thymic PTH”, produced by the medullary thymic epithelial cells (m-TECs). To the best of our knowledge, only a single case of well-documented PTH secretion from a thymoma causing primary hyperparathyroidism (PHTP) has been reported in the literature so far. We report here the case of a female patient with PHTP who underwent neck exploration for a suspected parathyroid adenoma. After surgery, a normalization of serum PTH concentration was observed, but the histological examination of the surgically excised mass revealed exclusively normal thymus tissue. The present case provides additional evidence of PHTP caused by an ectopic thymus. 

scholarly journals Intraoperative serum parathyroid hormone level is an indicator of hypocalcaemia in total thyroidectomy patients

2013 ◽  
Vol 38 (3) ◽  
pp. 84-89 ◽  
Author(s):  
MS Islam ◽  
T Sultana ◽  
D Paul ◽  
AHMZ Huq ◽  
AA Chowdhury ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Predictive Value ◽  
Clinical Pathology ◽  
High Sensitivity ◽  
Intraoperative Pth ◽  
Serum Pth ◽  
Sensitivity Specificity ◽  
Postoperative Hypocalcaemia ◽  
Pth Level

Postoperative hypocalcaemia is the most frequent and common complication after total thyroidectomy. It is necessary to diagnose or to predict hypocalcaemia immediately after total thyroidectomy for minimizing complications. A prospective observational study was carried out in the Department of Clinical Pathology in collaboration with Department of Microbiology & Immunology, Department of Surgery, Department of Otolaryngology, Bangabandhu Sheikh Mujib Medical University (BSMMU) and Department of Otolaryngology, Dhaka Medical College & Hospital (DMC&H), Dhaka, during the period of September 2010 to August 2011 to evaluate intraoperative (20 minutes after total thyroidectomy) parathyroid hormone (PTH) measurement as a predictor of post thyroidectomy hypocalcaemia. Total 65 patients were enrolled in this study those came for total thyroidectomy. Postoperative hypocalcaemia developed in 25 cases. Intraoperative PTH was assessed and significant correlation was found between intraoperative PTH level and development of hypocalcaemia. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value of intraoperative serum PTH for prediction of post total thyroidectomy hypocalcaemia were 84.0%, 85.0%, 84.6%, 77.8%, and 89.5% respectively. Because of the high sensitivity, specificity and accuracy of intraoperative serum PTH of this study, the early prediction of hypocalcaemia could be made by single assay of intraoperative serum PTH level at 20 minutes after total thyroidectomy. DOI: http://dx.doi.org/10.3329/bmrcb.v38i3.14331 Bangladesh Med Res Counc Bull 2012; 38(3): 84-89 (December)

ASSOCIATION BETWEEN HIGH LEVELS OF PARATHYROID HORMONE AND FRAILTY: THE NEPEAN OSTEOPOROSIS AND FRAILTY (NOF) STUDY

2018 ◽  
pp. 1-5
Author(s):  
L. Murthy ◽  
P. Dreyer ◽  
P. Suriyaarachchi ◽  
F. Gomez ◽  
C.L. Curcio ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Grip Strength ◽  
Multinomial Logistic Regression ◽  
Cross Sectional Study ◽  
Community Dwelling ◽  
Gait Velocity ◽  
Older Individuals ◽  
Cross Sectional ◽  
Serum Pth

Background: Frailty is associated with poor outcomes hence identification of risks factors is pivotal. Since the independent role of parathyroid hormone (PTH) in frailty remains unexplored, we aimed to determine this in a population of older individuals with a history of falling. Design: Cross-sectional study. Setting: Falls and Fracture Clinic, Nepean Hospital (Penrith, Australia). Participants: 692 subjects (mean age=79, 65% women) assessed between 2009-2015. Measurements: Assessment included clinical examination, mood, nutrition, grip strength, gait velocity, bone densitometry and posturography. Chemistry included serum PTH, calcium, vitamin D (25(OH)D3), creatinine and albumin. Normocalcemic subjects were divided into 4 groups: (1) Normal: 25(OH)D3 >50nmol/L and PTH between 1.6-6.8pmol/L; (2) PTH responsive: low 25(OH)D3 (<50nmol/L) and high PTH (>6.8pmol/L); (3) PTH unresponsive: low 25(OH)D3 and normal PTH; (4) Hyper PTH (>6.8pmol/L) with normal 25(OH)D3. Frailty was defined using Fried’s criteria. Difference between the groups was assessed using one-way ANOVA and X2 analysis. Multinomial logistic regression evaluated the association between the groups and the number of Fried’s criteria adjusted for age, BMI, renal function, 25(OH)D3 levels, and albumin. Results: 22.6% subjects had high PTH levels (>6.8pmol/L). All subjects in the high PTH groups had significantly lower grip strength, gait velocity, limits of stability, and higher BMI. The PTH responsive group had a higher risk of pre-frailty (β=3.8, 95% CI = 3.42 – 5.22, p< 0.01) and frailty (β=8.26, 95% CI = 2.8-16.1, p<0.01). The risk of frailty was also higher in the Hyper PTH group (β=2.3, 95% CI = 1.74-4.32, p<0.01). Conclusion: We have reported an independent association of high PTH levels with high number of falls and with the clinical components of physical frailty in community dwelling older persons. Our results suggest a possible role of PTH in frailty that deserves further exploration.

scholarly journals Intact parathyroid hormone levels localize causative glands in persistent or recurrent renal hyperparathyroidism: A retrospective cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0248366
Author(s):  
Takahisa Hiramitsu ◽  
Toshihide Tomosugi ◽  
Manabu Okada ◽  
Kenta Futamura ◽  
Norihiko Goto ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Area Under The Curve ◽  
Parathyroid Glands ◽  
Total Parathyroidectomy ◽  
Renal Hyperparathyroidism ◽  
Intact Pth ◽  
Receiver Operating Characteristic Curves ◽  
Detailed Imaging ◽  
Forearm Autograft ◽  
Pth Level

Persistent or recurrent renal hyperparathyroidism may occur after total parathyroidectomy and transcervical thymectomy with forearm autograft under continuous stimulation due to uremia. Parathyroid hormone (PTH) levels may reflect persistent or recurrent renal hyperparathyroidism because of the enlarged autografted parathyroid glands in the forearm or remnant parathyroid glands in the neck or mediastinum. Detailed imaging requires predictive localization of causative parathyroid glands. Casanova and simplified Casanova tests may be convenient. However, these methods require avascularization of the autografted forearm for >10 min with a tourniquet or Esmarch. The heavy pressure during avascularization can be incredibly painful and result in nerve damage. An easier method that minimizes the burden on patients in addition to predicting the localization of causative parathyroid glands was developed in this study. Ninety patients who underwent successful re-parathyroidectomy for persistent or recurrent renal hyperparathyroidism after parathyroidectomy between January 2000 and July 2019 were classified according to the localization of causative parathyroid glands (63 and 27 patients in the autografted forearm and the neck or mediastinum groups, respectively). Preoperatively, intact PTH levels were measured from bilateral forearm blood samples following a 5-min avascularization of the autografted forearm. Cutoff values of the intact PTH ratio (intact PTH level obtained from the non-autografted forearm before re-parathyroidectomy/intact PTH level obtained from the autografted forearm before re-parathyroidectomy) were investigated with receiver operating characteristic curves to localize the causative parathyroid glands. Intact PTH ratios of <0.310 with an area under the curve (AUC) of 0.913 (95% confidence interval [CI]: 0.856–0.970; P < 0.001) and >0.859 with an AUC 0.744 (95% CI: 0.587–0.901; P = 0.013) could predict causative parathyroid glands in the autografted forearm and the neck or mediastinum with diagnostic accuracies of 81.1% and 83.3%, respectively. Therefore, we propose that the intact PTH ratio is useful for predicting the localization of causative parathyroid glands for re-parathyroidectomy.

The Value of Intraoperative Quick Parathyroid Hormone Assay in Patients with Renal Hyperparathyroidism

2005 ◽  
Vol 5 (2) ◽  
pp. 93
Author(s):  
Woo Young Kim ◽  
Gil Soo Son ◽  
Jeoung Won Bae ◽  
Bum Hwan Koo ◽  
Jae Bok Lee
Keyword(s):  
Parathyroid Hormone ◽  
Renal Hyperparathyroidism ◽  
Parathyroid Hormone Assay ◽  
Hormone Assay

The Use of an Intact Molecule Parathyroid Hormone Assay in Disorders of Calcium Metabolism

1988 ◽  
Vol 25 (4) ◽  
pp. 367-372 ◽  
Author(s):  
E J Bicknell ◽  
W Van't Hoff
Keyword(s):  
Renal Failure ◽  
Alkaline Phosphatase ◽  
Parathyroid Hormone ◽  
Calcium Metabolism ◽  
Human Parathyroid Hormone ◽  
Normal Range ◽  
Intact Molecule ◽  
Parathyroid Hormone Assay ◽  
Plasma Alkaline Phosphatase ◽  
Pth Level

We present the results obtained using a 1–84 human parathyroid hormone (PTH) assay in patients with abnormal calcium metabolism. A normal range was established in a series of healthy volunteers. Patients with surgically proven hyperparathyroidism (HPT) showed increased PTH levels which were separate from the normal range. Patients with probable hyperparathyroidism and milder hypercalcaemia showed a raised median PTH level but the range overlapped with normal. Patients with hypercalcaemia of malignancy showed reduced PTH levels and these patients were readily differentiated from those with probable and proven HPT by the use of the assay. In patients with chronic renal failure PTH values ranged from normal to high, the PTH concentration was found to be correlated with plasma alkaline phosphatase, but not with plasma creatinine.

Clinical Evaluation of a Rapid Parathyroid Hormone Assay

1992 ◽  
Vol 29 (1) ◽  
pp. 48-51 ◽  
Author(s):  
M F Ryan ◽  
S R Jones ◽  
A D Barnes
Keyword(s):  
Renal Failure ◽  
Parathyroid Hormone ◽  
Intraoperative Monitoring ◽  
Frozen Section ◽  
Peripheral Circulation ◽  
Successful Completion ◽  
Parathyroid Hormone Assay ◽  
Rate Of Decline ◽  
Serum Pth ◽  
Accurate Quantification

Modifications to the incubation conditions of radioimmunoradiometric assay for whole molecule parathyroid hormone (PTH) permit accurate quantification of the hormone in the peripheral circulation within 1 h of sampling. We assessed the assay intraoperatively in 75 patients undergoing parathyroidectomy. Serum PTH concentration declined to less than 20% of its pre-operative value within 20 min of the successful completion of surgery provided that renal function was normal. In patients with chronic renal failure the rate of decline in serum PTH concentration after parathyroidectomy was slower in some cases. In four cases of unsuccessful parathyroidectomy, serum PTH concentration remained above 60% of its pre-operative value. Intraoperative monitoring during parathyroidectomy using this rapid PTH assay offers considerable advantages to the surgeon over frozen section.

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