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Secondary hyperparathyroidism (SHPT) is a multisystemic syndrome that affects calcium and bone homeostasis in patients with chronic kidney disease (CKD). Despite medical treatment, 1-2% of patients require parathyroidectomy anually. The use of an intraoperative paratohormone protocol (IOPTH) to predict cure still in debate, due to the lack of standardized protocols, the use of different assays and uneven PTH clearance. The aim of this study was to determine the diagnostic accuracy of an IOPTH in patients with SHPT for predicting successful surgery after parathyroidectomy.
A prospective observational study (cohort) was performed in patients who were submitted to parathyroidectomy by an endocrine surgeon for SHPT. All were submitted to a bilateral neck exploration with a subtotal parathyroidectomy. Three IOPTH determinations were withdrawn: at anesthetic induction (PTH0), 15 minutes (PTH15), and 30 minutes (PTH30) after completion gland resection. Another sample was taken 24 hours after the procedure (PTH24), values <150pg/mL defined a successful surgery and patients were assigned to the successful or unsuccessful group. IOPTH drop was analyzed to predict successful surgery with drops of 70% and 90% at 15 and 30 minutes.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Succesful surgery | PTH 24 hours after surgery <150pg/mL |
| |
| Unsuccessful surgery | PTH 24 hours after surgery >150pg/mL |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Intraoperative Paratohormone | Diagnostic Test | Three IOPTH determinations were withdrawn: at anesthetic induction (PTH0), 15 minutes (PTH15), and 30 minutes (PTH30) after completion gland resection. Another sample was taken 24 hours after the procedure (PTH24), values <150pg/mL defined a successful surgery and patients were assigned to the successful or unsuccessful group. IOPTH drop was analyzed to predict successful surgery with drops of 70% and 90% at 15 and 30 minutes. |
| Measure | Description | Time Frame |
|---|---|---|
| Successful surgery | Biochemical response to subtotal prathyroidectomy | 24 hours |
| Measure | Description | Time Frame |
|---|---|---|
| PTH drop | Drop from baseline, aiming a drop >70% | 15 minutes and 30 minutes after resection |
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Inclusion Criteria:
Exclusion Criteria:
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Patients with chronic kidney disease and secondary hyperparathyroidism
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| Name | Affiliation | Role |
|---|---|---|
| Karla V Chavez-Tostado, MD | SEDESA | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hospital General Ajusco Medio | Mexico City | 14250 | Mexico |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 19836494 | Result | Pitt SC, Sippel RS, Chen H. Secondary and tertiary hyperparathyroidism, state of the art surgical management. Surg Clin North Am. 2009 Oct;89(5):1227-39. doi: 10.1016/j.suc.2009.06.011. | |
| 11229970 | Result | IV. NKF-K/DOQI Clinical Practice Guidelines for Anemia of Chronic Kidney Disease: update 2000. Am J Kidney Dis. 2001 Jan;37(1 Suppl 1):S182-238. doi: 10.1016/s0272-6386(01)70008-x. No abstract available. |
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| ID | Term |
|---|---|
| D006962 | Hyperparathyroidism, Secondary |
| ID | Term |
|---|---|
| D006961 | Hyperparathyroidism |
| D010279 | Parathyroid Diseases |
| D004700 | Endocrine System Diseases |
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