Archives of Head and Neck Surgery
https://www.archivesheadnecksurgery.com/article/doi/10.4322/ahns.2019.0011
Archives of Head and Neck Surgery
Original Article Parathyroid diseases and tumors

Analysis of PTH serum concentration from internal jugular veins of patients with primary hyperparathyroidism

Davi Knoll Ribeiro*, Mayra Messias Lera, Ana Beatriz Ribeiro Fonseca, Murilo Catafesta das Neves

Downloads: 3
Views: 1031

Abstract

Introduction: Primary hyperparathyroidism (PHPT) is a common disease, ranking third among endocrinological disorders. Surgical intervention remains the only curative therapy for hyperparathyroidism patients. Objective: To evaluate whether the values of parathyroid hormone (PTH) collected from the internal jugular veins of patients with primary hyperparathyroidism can assist in the surgical approach. Methods: Prospective study of patients who underwent parathyroid adenoma excision by PHPT, collected right and left internal jugular vein blood sample for analysis of Parathyroid Hormone. Results: Twenty-nine patients underwent surgery. All patients had a decrease in peripheral PTH greater than 50% with a mean of 73.47%. PTH collection from the internal jugular veins was positive regarding the confirmation of parathyroid adenoma laterality in 22 cases (75.86%) and failure in 7 cases (24.14%), (p-value 0.001). Comparing the success rates of the methoxyisobutylisonitrile parathyroid scintigraphy (MIBI) tests, parathyroid ultrasonography (USG) and PTH of internal jugulars in relation to location of adenoma laterality, we observed MIBI as localizer in 89.65% of the cases followed by the Jugular PTH with 75.86% and USG with 44.82%. Conclusion: PTH collection from the internal jugular veins is useful in patients with primary hyperparathyroidism who underwent surgery as a possible method of localizatory exams, indicating adenoma laterality.

Keywords

primary hyperparathyroidism; parathyroidectomy; parathyroid hormone; jugular veins.

References

1. Fraser WD. Hyperparathyroidism. Lancet. 2009;374(9684):145-58. http://dx.doi.org/10.1016/S0140-6736(09)60507-9. PMid:19595349.

2. Eigelberger MS, Clark OH. Surgical approaches to primary hyperparathyroidism. Endocrinol Metab Clin North Am. 2000;29(3):479-502. http://dx.doi.org/10.1016/S0889-8529(05)70147-X. PMid:11033757.

3. Lundgren E, Hagstrom EG, Lundin J, Winnerback K, Roos J, Ljunghall S, Rastad J. Primary hyperparathyroidism revisited in menopausal women with serum calcium in the upper normal range at population-based screening 8 years ago. World J Surg. 2002;26(8):931-6. http://dx.doi.org/10.1007/s00268-002-6621-0. PMid:12045863.

4. Siilin H, Lundgren E, Mallmin H, Mellström D, Ohlsson C, Karlsson M, Orwoll E, Ljunggren O. Prevalence of primary hyperparathyroidism and impact on bone mineral density in elderly men: MrOs Sweden. World J Surg. 2011;35(6):1266-72. http://dx.doi.org/10.1007/s00268-011-1062-2. PMid:21445668.

5. Rao DS, Honasoge M, Divine GW, Phillips ER, Lee MW, Ansari MR, Talpos GB, Parfitt AM. Effect of vitamin D nutrition on parathyroid adenoma weight: pathogenetic and clinical implications. J Clin Endocrinol Metab. 2000;85(3):1054-8. http://dx.doi.org/10.1210/jc.85.3.1054. PMid:10720039.

6. Chen H, Zeiger MA, Gordon TA, Udelsman R. Parathyroidectomy in Maryland: Effects of an endocrine center. Surgery. 1996;120(6):948-52. http://dx.doi.org/10.1016/S0039-6060(96)80039-0. PMid:8957479.

7. Chen H, Mack E, Starling JR. Radioguided parathyroidectomy is equally effective for both adenomatous and hyperplastic glands. Ann Surg. 2003;238(3):332-8. PMid:14501499.

8. Udelsman R. Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg. 2002;235(5):665-70. http://dx.doi.org/10.1097/00000658-200205000-00008. PMid:11981212.

9. Carneiro-Pla D. Effectiveness of office”-based, ultrasound-guided differential jugular venous sampling (DJVS) of parathormone in patients with primary hyperparathyroidism. Surgery. 2009;146(6):1014-20. http://dx.doi.org/10.1016/j.surg.2009.09.033. PMid:19958928.

10. Ito F, Sippel R, Lederman J, Chen H. The utility of intraoperative bilateral internal jugular venous sampling with rapid parathyroid hormone testing. Ann Surg. 2007;245(6):959-63. http://dx.doi.org/10.1097/01.sla.0000255578.11198.ff. PMid:17522522.

11. Ibraheem K, Toraih EA, Haddad AB, Farag M, Randolph GW, Kandil E. Selective Parathyroide Venous Sampling in Primary Hyperparathyroidism: A systematic review and meta-analysis. Laryngoscope. 2018;128(11):1-6. http://dx.doi.org/10.1002/lary.27213. PMid:29756350.

12. Neves MC, Ohe MN, Rosano M, Abrahão M, Cervantes O, Lazaretti-Castro M, Vieira JG, Kunii IS, Santos RO. A 10-Year Experience in Intraoperative Parathyroid Hormone Measurements for Primary Hypreparathyroidism: A Prospective Study of 91 Previous Unexplored Patients. J Osteoporos. 2012;2012:1-6. http://dx.doi.org/10.1155/2012/914214. PMid:22523718.

13. Horton NJ, Kleinman K. Using R for Data Management, Statistical Analysis, and Graphics CRC Press. Boca Raton: Chapman and Hall; 2010

14. Zar JH. Biostatistical analysis. 5th ed. New Jersey: Pearson Prentice-Hall; 2010.

15. Maceri DR, Kokot N, Green K, Montgomery V, Sharifi J. Split central venous sampling of Parathyroid Hormone: An adjunct to surgical exploration. Head Neck. 2011;33(12):1715-8. http://dx.doi.org/10.1002/hed.21659. PMid:21322077.

16. Yamada T, Ikuno M, Shinjo Y, Hiroishi A, Matsushita S, Morimoto T, Kumano R, Yagihashi K, Katabami T. Selective venous sampling for primary hyperparathyroidism: How to perform an examination and interpret the results with reference to thyroid vein anatomy. Jpn J Radiol. 2017;35(8):409-16. http://dx.doi.org/10.1007/s11604-017-0658-3. PMid:28639211.

17. Wafae N, Hirose K, Franco C, Wafae GC, Ruiz CR, Daher L, Person OC. The anatomy of the human thyroid veins and its surgical application. Folia Morphol. 2008;67(4):221-5. PMid:19085858.

18. Alvarado R, Meyer-Rochow G, Sywak M, Delbridge L, Sidhu S. Bilateral internal jugular venous sampling for parathyroid hormone determination in patients with nonlocalizing primary hyperparathiroidism. World J Surg. 2010;34(6):1299-303. http://dx.doi.org/10.1007/s00268-010-0556-7. PMid:20372897.

19. Barczynski M, Konturek A, Hubalewska-Dydejczyk A, Cichon S, Nowak W. Utility of intraoperative bilateral internal jugular venous sampling with rapid parathyroid hormone testing in guiding patients with a negative sestamibi scan for minimally invasive parathyroidectomy – A randomized controlled trial. Langenbecks Arch Surg. 2009;394(5):827-35. http://dx.doi.org/10.1007/s00423-009-0516-6. PMid:19529955.
5e1375ad0e88255e3a27eaa2 archives Articles
Links & Downloads

Arch. Head Neck Surg.

Share this page
Page Sections