caa a22 4500 475803248 CHVBK 20180406123743.0 cr unu---uuuuu 170329e20000501xx s 000 0 eng 10.1007/s002689910091 doi (NATIONALLICENCE)springer-10.1007/s002689910091 Intraoperative Parathormone Measurement in Patients with Multiple Endocrine Neoplasia Type I Syndrome and Hyperparathyroidism [Elektronische Daten] [Francesco Tonelli, Simona Spini, Mariasilvia Tommasi, Gianfranco Gabbrielli, Andrea Amorosi, Alessandro Brocchi, Maria Luisa Brandi] Abstract.: Total or subtotal parathyroidectomy is considered the treatment of choice for multiple endocrine neoplasia type I (MEN-I)-associated primary hyperparathyroidism (HPT). However, persistent or recurrent HPT is frequently observed. The development of a rapid two-site immunoradiometric assay (IRMA) method for measuring intact parathormone (PTH) has provided a valuable tool for recognizing possible surgical failures. Our experience includes 16 MEN-I patients (10 females, 6 males) of mean age 35.5 years operated on between 1990 and 1996. Total parathyroidectomy (TPTX) with autotransplantation of parathyroid tissue was the standard treatment. Blood samples for PTH measurement were drawn at the induction of anesthesia (basal value), 10 and 20 minutes after the removal of each gland, and 60 minutes after TPTX. Rapid PTH measurement, which required only 15 minutes of incubation at 37°C, showed a highly significant correlation (p < 0.0001) with the standard method. Circulating PTH levels exhibited a stepwise decrease during TPTX, reaching a mean value of 22.3% of the baseline 20 minutes after removal of the last gland. Two patients showed a prompt decrease of PTH after removal of the single enlarged gland, featuring the kinetics observed in the adenomas. One of these two patients was successfully treated with more conservative surgery. None of the patients showed persistence or recurrence of HPT. In our experience, intraoperative measurement of PTH seems to be a valuable adjunct in both the diagnosis of multiglandular involvement and the prediction of surgical treatment in patients with primary parathyroid hyperplasia. 2000 by the Société Internationale de Chir, 2000 Tonelli Francesco Surgery Unit, Department of Clinical Physiopathology, University of Florence Medical School, V. le Morgagni 85, 50134 Florence, Italy, IT aut Spini Simona Surgery Unit, Department of Clinical Physiopathology, University of Florence Medical School, V. le Morgagni 85, 50134 Florence, Italy, IT aut Tommasi Mariasilvia Nuclear Medicine Unit, Department of Clinical Physiopathology, University of Florence Medical School, V. le Morgagni 85, 50134 Florence, Italy, IT aut Gabbrielli Gianfranco Surgery Unit, Department of Clinical Physiopathology, University of Florence Medical School, V. le Morgagni 85, 50134 Florence, Italy, IT aut Amorosi Andrea Institute of Pathology, University of Florence Medical School, V. le Morgagni 85, 50134 Florence, Italy, IT aut Brocchi Alessandro Nuclear Medicine Unit, Department of Clinical Physiopathology, University of Florence Medical School, V. le Morgagni 85, 50134 Florence, Italy, IT aut Brandi Maria Luisa Endocrine Unit, Department of Clinical Physiopathology, University of Florence Medical School, V. le Pieraccini 6, 50139 Florence, Italy, IT aut World Journal of Surgery Springer-Verlag 24/5(2000-05-01), 556-563 0364-2313 24:5<556 2000 24 268 https://doi.org/10.1007/s002689910091 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s002689910091 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Tonelli Francesco Surgery Unit, Department of Clinical Physiopathology, University of Florence Medical School, V. le Morgagni 85, 50134 Florence, Italy, IT aut NATIONALLICENCE 700 1- Spini Simona Surgery Unit, Department of Clinical Physiopathology, University of Florence Medical School, V. le Morgagni 85, 50134 Florence, Italy, IT aut NATIONALLICENCE 700 1- Tommasi Mariasilvia Nuclear Medicine Unit, Department of Clinical Physiopathology, University of Florence Medical School, V. le Morgagni 85, 50134 Florence, Italy, IT aut NATIONALLICENCE 700 1- Gabbrielli Gianfranco Surgery Unit, Department of Clinical Physiopathology, University of Florence Medical School, V. le Morgagni 85, 50134 Florence, Italy, IT aut NATIONALLICENCE 700 1- Amorosi Andrea Institute of Pathology, University of Florence Medical School, V. le Morgagni 85, 50134 Florence, Italy, IT aut NATIONALLICENCE 700 1- Brocchi Alessandro Nuclear Medicine Unit, Department of Clinical Physiopathology, University of Florence Medical School, V. le Morgagni 85, 50134 Florence, Italy, IT aut NATIONALLICENCE 700 1- Brandi Maria Luisa Endocrine Unit, Department of Clinical Physiopathology, University of Florence Medical School, V. le Pieraccini 6, 50139 Florence, Italy, IT aut NATIONALLICENCE 773 0- World Journal of Surgery Springer-Verlag 24/5(2000-05-01), 556-563 0364-2313 24:5<556 2000 24 268 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer