Risk factors for "PTH spikes" during surgery for primary hyperparathyroidism

Area of Science:

• Endocrinology
• Surgical Oncology
• Clinical Chemistry

Background:

• Intraoperative parathyroid hormone (PTH) spikes, caused by adenoma manipulation, complicate interpretation of PTH curves during primary hyperparathyroidism surgery.
• Accurate interpretation of intraoperative PTH levels is crucial for surgical success and avoiding complications.

Purpose of the Study:

• To identify risk factors for PTH spikes during primary hyperparathyroid surgery.
• To evaluate the impact of PTH spikes on the interpretation of various intraoperative PTH criteria (Vienna, Miami, Halle).

Main Methods:

• Analysis of 847 patients undergoing surgery for primary hyperparathyroidism.
• Assessment of preoperative PTH and creatinine levels, and adenoma size as potential risk factors for PTH spikes.
• Evaluation of the influence of PTH spikes on Vienna, Miami, and Halle interpretation criteria.

Main Results:

• PTH spikes occurred in 12% of patients and were not linked to preoperative PTH, creatinine levels, or adenoma size.
• Smaller adenomas and lower baseline PTH correlated with higher intraoperative PTH manipulation values.
• No criterion showed increased false-positive misclassification due to PTH spikes, but the Vienna criterion had increased false-negative rates with higher manipulation values.

Conclusions:

• PTH spikes do not significantly increase the risk of missed adenomas across analyzed criteria.
• The Vienna criterion may lead to unnecessary explorations with increasing PTH manipulation values.
• The Miami criterion is suggested as a favorable option for interpreting PTH curves in patients experiencing PTH spikes.