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The time has come to redefine the classic symptoms of primary hyperparathyroidism: comment on “parathyroidectomy, elevated depression scores, and suicidal ideation in patients with primary hyperparathyroidism”.

Department of Surgery and Oncology, University of Calgary, Calgary, Alberta, Canada.
JAMA SURGERY (Impact Factor: 4.3). 02/2013; 148(2):115-6.
Source: PubMed
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    ABSTRACT: Our aim was to determine whether chronic renal insufficiency (CRI) impacted intraoperative parathyroid hormone (ioPTH) monitoring during parathyroidectomy. We hypothesized that ioPTH monitoring in patients with CRI would show slower decline, but would still accurately predict cure. A retrospective review was conducted of patients with primary hyperparathyroidism who underwent curative single adenoma parathyroidectomy. The percentage of patients reaching 50% decline of ioPTH was compared between groups stratified by renal function. Between 2000 and 2013, 950 patients met inclusion criteria. At 5 minutes, 66% of patients with CRI met curative criteria versus 77% of normal renal function patients (P = .001). At 10 minutes, 89% vs 92% met criteria (P = .073), and by 15 minutes, the gap narrowed to 95% vs 97% (P = .142), respectively. Despite CRI patients with primary hyperparathyroidism having slower ioPTH decline after curative parathyroidectomy, 95% met ioPTH criteria by 15 minutes. Standard ioPTH criteria can be used with CRI patients. Copyright © 2015 Elsevier Inc. All rights reserved.
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