Lateralization of parathyroid adenomas by intra-operative parathormone estimation

A simple method for intra-operative lateralization of parathyroid adenomas by venous sampling for intact parathormone (PTH [1-84] is described. After induction of anaesthesia, percutaneous right and left internal jugular and arm vein PTH [1-84] was estimated within 30 minutes by a modification of the Allegro PTH [1-84] assay. Twenty-three patients with primary hyperparathyroidism due to adenoma were explored, 21 with one adenoma and two with two adenomas. Intraoperative jugular PTH [1-84] correctly lateralized 16 (76%) of the single adenomas (P < 0.006), and the side of the neck with the greater weight of parathyroid adenoma in 18 (78%) patients (P < 0.004). Two patients with previous failed neck explorations were correctly lateralized. Thallium/technetium scanning lateralized 41%, significantly less then jugular PTH [1-84] (P < 0.02). Adenomas of 1 g or less were more likely to be lateralized by PTH [1-84] than thallium/technetium scanning (P < 0.05). Intraoperative jugular PTH [1-84] was superior to thallium/technetium scanning for parathyroid adenoma lateralization.