[Importance of intraoperative parathormone measurements in primary hyperparathyroidism with 5-gland hyperplasia]

While intraoperative parathormone measurements are mandatory for unilateral operations of primary hyperparathyroidism (pHPT), its value for treatment of parathyroid hyperplasia is regarded as insufficient. We report a case of a pHPT with hyperplasia of five glands, in which only the intraoperative analysis of parathormone detected the remaining fifth hyperparathyroid gland after extirpation of four enlarged parathyroid glands. We describe technical problems involved in the tests available today and how the results of the intraoperative parathormone test need to be interpreted. As several factors can influence the decrease in parathormone concentration, a kinetic analysis may be more accurate in assessing the adequacy of resection. Therefore, intraoperative parathormone measurements are especially useful and important for adequate surgical therapy for pHPT with parathyroid hyperplasia.