만성신부전증환자에서 부갑상선 절제술 시 수술 중 급속 부갑상선 호르몬 측정의 의의

The Value of Intraoperative Quick Parathyroid Hormone Assay in Patients with Renal Hyperparathyroidism

Purpose: Intraoperative quick parathyroid hormone assay (PTH) was introduced in the parathyroid surgery since 1988 and the value in patients with primary hyperparathyroidism was well recognized in the literature. The purpose of this study was to evaluate the usefulness of intraoperative rapid PTH assay in patients with renal hyperparathyroidism by comparing intraoperative PTH results and the biochemical results at postoperative 6<SUP>th</SUP> month, including PTH values. Methods: Fifteen consecutive patients of renal hyperpara</SUP>thyroidism underwent total parathyroidectomy and immediate autotransplantation from November 2003 to February 2005. PTH levels were measured by PTH assay at the induction of anesthesia (baseline level) and in 20-minute intervals after excision of the last parathyroid gland. More than 50% drop of initial PTH level was considered as completeness of parathyroidectomy. Results: Twenty minutes after resection, PTH levels decreased by 83.7% in 14 patients and by 50.2% in one patient. Ten patients (67%) were cured but 5 patients (34%) showed high PTH levels after 6 months. The drop rate of intraoperative quick PTH level in cured patients was 92% at 26 minutes after parathyroidectomy and was significantly different from 73.3% of persistent or recurrent five patients (P=0.047). Preoperative PTH level, calcium level, alkaline phosphatase level and preoperative localization were not different in the cured and recurrent or persistent patients of renal hyperparathyroidism. Conclusion: The value of intraoperative quick PTH assayin patients of renal hyperparathyroidism was questionable. More than 92% drop of intraoperative PTH level at 26 minutes after parathyroidectomy could predict success in our study. (Korean J Endocrine Surg 2005;5:93-99)