Parathyroid adenoma other diagnostic studies

Jump to navigation Jump to search

Parathyroid adenoma Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Parathyroid Adenoma from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Parathyroid adenoma other diagnostic studies On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Parathyroid adenoma other diagnostic studies

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Parathyroid adenoma other diagnostic studies

CDC on Parathyroid adenoma other diagnostic studies

Parathyroid adenoma other diagnostic studies in the news

Blogs on Parathyroid adenoma other diagnostic studies

Directions to Hospitals Treating Psoriasis

Risk calculators and risk factors for Parathyroid adenoma other diagnostic studies

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2]

Overview

Other diagnostic study useful for preoperative localization of hyper-functioning parathyroid glands include super selective venous sampling. Another diagnostic study include measurement of intraoperative parathyroid hormone (IOPTH) by using a modified sensitive assay (immunoradiometric assay). IOPTH is beneficial for predicting long term surgical outcomes.

Other Diagnostic Studies

Super Selective Venous Sampling

  • Real-time super selective venous sampling (sSVS) is the most common invasive modality for preoperative localization of hyper-functioning parathyroid glands.[1]
  • Real-time sSVS is a highly sensitive and specific technique used when traditional non-invasive imaging studies fail to localize hyper-functioning parathyroid glands preoperatively in patients with persistent or recurrent primary hyperparathyroidism.[2]
  • Patients with a 2-fold gradient or more in cervical vein drainage locations (inferior, middle, and superior thyroid veins; thymic and vertebral veins) compared to the baseline value in the iliac vein are considered for exploration.[3]

Intraoperative parathyroid hormone (IOPTH)

Technique for intraoperative parathyroid hormone (IOPTH) monitoring

  • When the enlarged parathyroid gland is first visualized intraoperatively, a baseline sample should be obtained.[9]
  • The baseline sample should never be obtained before induction of anesthesia. It is due to the fact that an increase in parathyroid hormone level may be observed after general anesthesia.
  • After excision of enlarged gland, 2nd and 3rd samples are collected at 5 and 10 minutes respectively.
  • Several criteria are used for predicting post-operative normocalcemia including:

References

  1. Lebastchi AH, Aruny JE, Donovan PI, Quinn CE, Callender GG, Carling T; et al. (2015). "Real-Time Super Selective Venous Sampling in Remedial Parathyroid Surgery". J Am Coll Surg. 220 (6): 994–1000. doi:10.1016/j.jamcollsurg.2015.01.004. PMID 25868412.
  2. Sugg SL, Fraker DL, Alexander R, Doppman JL, Miller DL, Chang R; et al. (1993). "Prospective evaluation of selective venous sampling for parathyroid hormone concentration in patients undergoing reoperations for primary hyperparathyroidism". Surgery. 114 (6): 1004–9, discussion 1009-10. PMID 8256203.
  3. Powell AC, Alexander HR, Chang R, Marx SJ, Skarulis M, Pingpank JF; et al. (2009). "Reoperation for parathyroid adenoma: a contemporary experience". Surgery. 146 (6): 1144–55. doi:10.1016/j.surg.2009.09.015. PMC 3467310. PMID 19958942.
  4. Nussbaum SR, Thompson AR, Hutcheson KA, Gaz RD, Wang CA (1988). "Intraoperative measurement of parathyroid hormone in the surgical management of hyperparathyroidism". Surgery. 104 (6): 1121–7. PMID 3194839.
  5. Bergenfelz A, Isaksson A, Ahrén B (1994). "Intraoperative monitoring of intact PTH during surgery for primary hyperparathyroidism". Langenbecks Arch Chir. 379 (1): 50–3. PMID 8145618.
  6. Irvin III, George L.; Dembrow, Victor D.; Prudhomme, David L. (December 1993). "Clinical usefulness of an intraoperative "quick parathyroid hormone" assay". Surgery. 114 (6): 1019–1023.
  7. Bergenfelz A, Isaksson A, Lindblom P, Westerdahl J, Tibblin S (1998). "Measurement of parathyroid hormone in patients with primary hyperparathyroidism undergoing first and reoperative surgery". Br J Surg. 85 (8): 1129–32. doi:10.1046/j.1365-2168.1998.00824.x. PMID 9718013.
  8. Boggs JE, Irvin GL, Molinari AS, Deriso GT (1996). "Intraoperative parathyroid hormone monitoring as an adjunct to parathyroidectomy" (PDF). Surgery. 120 (6): 954–8. doi:10.1016/S0039-6060(96)80040-7. PMID 8957480.
  9. Westerdahl J, Lindblom P, Bergenfelz A (2002). "Measurement of intraoperative parathyroid hormone predicts long-term operative success". Arch Surg. 137 (2): 186–90. doi:10.1001/archsurg.137.2.186. PMID 11822958.

Template:WH Template:WS