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Intraoperative parathormone monitoring to predict operative success in patients with normohormonal hyperparathyroidism

Heather Stuart, Basem Azab, Omar Picado Roque, Janice Pasieka and John I. Lew
Can J Surg July 28, 2022 65 (4) E468-E473; DOI: https://doi.org/10.1503/cjs.013220
Heather Stuart
From the Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Fla. (Stuart, Azab); the Division of Surgical Oncology, Department of Surgery, University of British Columbia, Vancouver, BC (Stuart); the Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Fla. (Picado Roque, Lew); and the Division of Surgical Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Pasieka)
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Basem Azab
From the Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Fla. (Stuart, Azab); the Division of Surgical Oncology, Department of Surgery, University of British Columbia, Vancouver, BC (Stuart); the Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Fla. (Picado Roque, Lew); and the Division of Surgical Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Pasieka)
MD
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Omar Picado Roque
From the Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Fla. (Stuart, Azab); the Division of Surgical Oncology, Department of Surgery, University of British Columbia, Vancouver, BC (Stuart); the Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Fla. (Picado Roque, Lew); and the Division of Surgical Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Pasieka)
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Janice Pasieka
From the Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Fla. (Stuart, Azab); the Division of Surgical Oncology, Department of Surgery, University of British Columbia, Vancouver, BC (Stuart); the Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Fla. (Picado Roque, Lew); and the Division of Surgical Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Pasieka)
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John I. Lew
From the Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Fla. (Stuart, Azab); the Division of Surgical Oncology, Department of Surgery, University of British Columbia, Vancouver, BC (Stuart); the Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Fla. (Picado Roque, Lew); and the Division of Surgical Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Pasieka)
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    Fig. 1

    Proportion of patients with classic primary hyperparathyroidism (pHPT) and normohormonal hyperparathyroidism (nhHPT) who had an intraoperative decrease of more than 50% in parathormone level 5, 10 and 20 minutes after parathyroid removal. *p < 0.001. Error bars represent standard deviations.

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    Table 1

    Mean preoperative calcium and parathormone levels in patients with normohormonal hyperparathyroidism and primary hyperparathyroidism at the 2 study centres

    Group; variableCentre; no. (%) of patients*
    Calgary
    n = 62
    Miami
    n = 271
    Classic pHPT (n = 295)47 (75.8)248 (91.5)
    Preoperative calcium level, mean ± SD, mmol/L2.8 ± 0.22.8 ± 0.2
    Preoperative PTH level, mean ± SD, pg/dL113 ± 50151 ± 60
    nhHPT (n = 38)15 (24.2)23 (8.5)
    Preoperative calcium level, mean ± SD, mmol/L2.6 ± 0.12.7 ± 0.1
    Preoperative PTH level, mean ± SD, pg/dL52 ± 1054 ± 9
    • nhHPT = normohormonal hyperparathyroidism; pHPT = primary hyperparathyroidism;

    • PTH = parathormone; SD = standard deviation.

    • ↵* Except where noted otherwise.

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    Table 2

    Patient demographic characteristics

    CharacteristicNo. (%) of patients*p value
    Classic pHPT
    n = 295
    nhHPT
    n = 38
    Age, mean ± SD, yr59 ± 1458 ± 100.5
    Female sex239 (81.0)28 (73.7)0.3
    Preoperative calcium level, mean ± SD, mmol/L2.8 ± 0.22.7 ± 0.1< 0.001
    Preoperative PTH level, mean ± SD, pg/dL145 ± 6153 ± 9< 0.001
    Preoperative eucalcemia7 (2.4)2 (5.3)0.3
    • nhHPT = normohormonal hyperparathyroidism; pHPT = primary hyperparathyroidism; PTH = parathormone; SD = standard deviation.

    • ↵* Except where noted otherwise.

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Canadian Journal of Surgery: 65 (4)
Can J Surg
Vol. 65, Issue 4
30 Aug 2022
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Intraoperative parathormone monitoring to predict operative success in patients with normohormonal hyperparathyroidism
Heather Stuart, Basem Azab, Omar Picado Roque, Janice Pasieka, John I. Lew
Can J Surg Jul 2022, 65 (4) E468-E473; DOI: 10.1503/cjs.013220

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Intraoperative parathormone monitoring to predict operative success in patients with normohormonal hyperparathyroidism
Heather Stuart, Basem Azab, Omar Picado Roque, Janice Pasieka, John I. Lew
Can J Surg Jul 2022, 65 (4) E468-E473; DOI: 10.1503/cjs.013220
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