Validità, limiti ed indicazioni del dosaggio intraoperatorio del paratormone (I-PTH) ne ltrattamento chirurgico dell'iperparatiroidismo primario

Introduction - Recently new methods have been experienced to achieve the best surgical results in complete removal of pathological parathyroid tissue; serum I-PTH (1-84) rapid dosage is the most interesting and reliable method. Material and methods - In a group of 11 patients with IPP, diagnosed by high levels of I-PTH, total and ionized serum calcium, 7 were paucisymptomatic, 3 presented nephrolityasis, 1 acute pancreatitis and severe hypercalcemic crisis. No MEN were found. A systemic research of all paratyroid glands was always performed, then 10, 20, 30 and any 30 minutes after each parathyroidectomy serum I-PTH rapid dosage was made (rapid IRMA method) until the end of surgical treatment. Results - Eight single adenomas paratyroid were diagnosed, 1 double adenoma and 2 hyperplasia. All patients had high levels of serum I-PTH during pathologic paratyroid removal. The decrement of I-PTH level to 40% 10 min after parathyroidectomy, and 50% after 20 minutes confirmed the efficacy of surgery. Discussion - Intraoperative rapid dosage of I-PTH associated with anatomopathologic results leads to a successful diagnosis and therapy. Sometimes in multiglandular disease serum level of PTH dicreases after first parathyroidectomy as in a single adenoma: this underlines the importance of systematic surgical research of all glands in any case. Conclusion - In our experience serum I-PTH rapid dosage in IPP would be applied by specialized surgical equipes only in selected patients, such as reoperation or those few cases of first surgical treatment when ectopy is suspected.