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Updated: Jun 4, 2026
A Novel Method: Super-selective Adrenal Venous Sampling
Published on: September 15, 2017
Split central venous sampling of parathyroid hormone: an adjunct to surgical exploration
Dennis R Maceri1, Niels Kokot, Kathrine Green
1Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA. maceri@usc.edu
Background:
Minimally invasive parathyroid surgery mandates preoperative localization of the adenoma for a targeted operative approach. This technique uses split internal jugular vein parathyroid hormone (PTH) samples to determine a gradient that then directs the surgical exploration.
Methods:
Blood samples were drawn low in the neck from the jugular veins after the neck was opened. The p values for the difference in PTH between the right and left internal jugular veins were calculated with independent sample t tests.
Results:
For left-sided adenomas, the left internal jugular vein mean was significantly higher than the right p = .001). For right-sided adenomas, the right internal jugular vein mean was significantly higher than the left (p = .004). In hyperplasia, there was no significant difference (p = .43).
Conclusions:
This study demonstrates the usefulness of split PTH internal jugular vein samples in patients in whom preoperative localization failed. Eighty percent of these patients with a gradient were treated with site-directed unilateral exploration.
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