Impact of intraoperative intact PTH monitoring on reoperation rates and surgical success in primary hyperparathyroidism
Abstract Background Primary hyperparathyroidism (PHPT) is caused by excessive parathormone secretion from one or more parathyroid glands. The primary treatment for PHPT is surgery. Due to anatomical variations in the parathyroid glands, preoperative localization, surgical approaches, and success rat...
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BMC
2025-04-01
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| Series: | BMC Endocrine Disorders |
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| Online Access: | https://doi.org/10.1186/s12902-025-01942-z |
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| author | Farshad Noori Erdal Güceoğlu Yunushan Furkan Aydoğdu Çağrı Büyükkasap Ramazan Kozan Kürşat Dikmen Özlem Gülbahar Murat Akın Ömer Şakrak |
| author_facet | Farshad Noori Erdal Güceoğlu Yunushan Furkan Aydoğdu Çağrı Büyükkasap Ramazan Kozan Kürşat Dikmen Özlem Gülbahar Murat Akın Ömer Şakrak |
| author_sort | Farshad Noori |
| collection | DOAJ |
| description | Abstract Background Primary hyperparathyroidism (PHPT) is caused by excessive parathormone secretion from one or more parathyroid glands. The primary treatment for PHPT is surgery. Due to anatomical variations in the parathyroid glands, preoperative localization, surgical approaches, and success rates can vary. With the development of advanced imaging techniques and the introduction of intraoperative intact PTH (i-PTH) measurement, traditional extended surgical approaches have increasingly been replaced by focused surgeries. Objective Intraoperative i-PTH measurement has been applied by different surgeons using various criteria. This study aims to evaluate the effectiveness of intraoperative i-PTH measurement in improving surgical success, particularly in cases with inconclusive preoperative imaging results. Methods Between January 2010 and September 2020, 203 adult patients who underwent surgery for PHPT in our clinic were included in the study. Patients were categorized into two groups: Group A (with intraoperative i-PTH measurement) and Group B (without i-PTH measurement). Persistent hyperparathyroidism was defined as elevated calcium levels occurring shortly after surgery, whereas recurrence was defined as calcium elevation after the 6th postoperative month. The absence of recurrence or persistent hypercalcemia was considered an indicator of surgical success. Results The mean age of the patients was 54.6 ± 12.7 years. Of the 203 patients, 40 (19.7%) were male and 163 (80.3%) were female. No correlation was found between recurrence or persistence and patient age. The overall success rate was 93.6%. Surgical success was achieved in 97.8% of patients in Group A and 90% in Group B, indicating a statistically significant difference between the groups (p = 0.023). Conclusion Intraoperative i-PTH measurement significantly increases the success rate of PHPT surgery, reducing the incidence of recurrent or persistent cases and the need for secondary operations. Consequently, it helps prevent complications associated with reoperations. These findings highlight the pivotal role of intraoperative i-PTH monitoring in optimizing surgical outcomes, especially in complex PHPT cases. |
| format | Article |
| id | doaj-art-e4efd87786194c26a0bb90bfe091eb3e |
| institution | DOAJ |
| issn | 1472-6823 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
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| series | BMC Endocrine Disorders |
| spelling | doaj-art-e4efd87786194c26a0bb90bfe091eb3e2025-08-20T03:13:54ZengBMCBMC Endocrine Disorders1472-68232025-04-0125111110.1186/s12902-025-01942-zImpact of intraoperative intact PTH monitoring on reoperation rates and surgical success in primary hyperparathyroidismFarshad Noori0Erdal Güceoğlu1Yunushan Furkan Aydoğdu2Çağrı Büyükkasap3Ramazan Kozan4Kürşat Dikmen5Özlem Gülbahar6Murat Akın7Ömer Şakrak8Department of Gastroenterology Surgery, Bilkent City HospitalDepartment of General Surgery, Faculty of Medicine, Gazi UniversityDepartment of General Surgery, Ankara Training and Research HospitalDepartment of General Surgery, Faculty of Medicine, Gazi UniversityDepartment of General Surgery, Faculty of Medicine, Gazi UniversityDepartment of General Surgery, Faculty of Medicine, Gazi UniversityDepartment of Medical Biochemistry, Faculty of Medicine, Gazi UniversityDepartment of General Surgery, Faculty of Medicine, Gazi UniversityDepartment of General Surgery, Faculty of Medicine, Gazi UniversityAbstract Background Primary hyperparathyroidism (PHPT) is caused by excessive parathormone secretion from one or more parathyroid glands. The primary treatment for PHPT is surgery. Due to anatomical variations in the parathyroid glands, preoperative localization, surgical approaches, and success rates can vary. With the development of advanced imaging techniques and the introduction of intraoperative intact PTH (i-PTH) measurement, traditional extended surgical approaches have increasingly been replaced by focused surgeries. Objective Intraoperative i-PTH measurement has been applied by different surgeons using various criteria. This study aims to evaluate the effectiveness of intraoperative i-PTH measurement in improving surgical success, particularly in cases with inconclusive preoperative imaging results. Methods Between January 2010 and September 2020, 203 adult patients who underwent surgery for PHPT in our clinic were included in the study. Patients were categorized into two groups: Group A (with intraoperative i-PTH measurement) and Group B (without i-PTH measurement). Persistent hyperparathyroidism was defined as elevated calcium levels occurring shortly after surgery, whereas recurrence was defined as calcium elevation after the 6th postoperative month. The absence of recurrence or persistent hypercalcemia was considered an indicator of surgical success. Results The mean age of the patients was 54.6 ± 12.7 years. Of the 203 patients, 40 (19.7%) were male and 163 (80.3%) were female. No correlation was found between recurrence or persistence and patient age. The overall success rate was 93.6%. Surgical success was achieved in 97.8% of patients in Group A and 90% in Group B, indicating a statistically significant difference between the groups (p = 0.023). Conclusion Intraoperative i-PTH measurement significantly increases the success rate of PHPT surgery, reducing the incidence of recurrent or persistent cases and the need for secondary operations. Consequently, it helps prevent complications associated with reoperations. These findings highlight the pivotal role of intraoperative i-PTH monitoring in optimizing surgical outcomes, especially in complex PHPT cases.https://doi.org/10.1186/s12902-025-01942-zPrimary hyperparathyroidism (PHPT)Intraoperative parathyroid hormone (i-PTH)ParathyroidectomyPersistentRecurrence |
| spellingShingle | Farshad Noori Erdal Güceoğlu Yunushan Furkan Aydoğdu Çağrı Büyükkasap Ramazan Kozan Kürşat Dikmen Özlem Gülbahar Murat Akın Ömer Şakrak Impact of intraoperative intact PTH monitoring on reoperation rates and surgical success in primary hyperparathyroidism BMC Endocrine Disorders Primary hyperparathyroidism (PHPT) Intraoperative parathyroid hormone (i-PTH) Parathyroidectomy Persistent Recurrence |
| title | Impact of intraoperative intact PTH monitoring on reoperation rates and surgical success in primary hyperparathyroidism |
| title_full | Impact of intraoperative intact PTH monitoring on reoperation rates and surgical success in primary hyperparathyroidism |
| title_fullStr | Impact of intraoperative intact PTH monitoring on reoperation rates and surgical success in primary hyperparathyroidism |
| title_full_unstemmed | Impact of intraoperative intact PTH monitoring on reoperation rates and surgical success in primary hyperparathyroidism |
| title_short | Impact of intraoperative intact PTH monitoring on reoperation rates and surgical success in primary hyperparathyroidism |
| title_sort | impact of intraoperative intact pth monitoring on reoperation rates and surgical success in primary hyperparathyroidism |
| topic | Primary hyperparathyroidism (PHPT) Intraoperative parathyroid hormone (i-PTH) Parathyroidectomy Persistent Recurrence |
| url | https://doi.org/10.1186/s12902-025-01942-z |
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