Role of Cyclase Activating Parathyroid Hormone (1-84 PTH) Measurements During Parathyroid Surgery

作者：Hiroyuki Yamashita, Ping Hui Gao, Shiro Noguchi, Tom L. Cantor, Shinya Uchino, Shin Watanabe, Hiroto Yamashita, Hitoshi Kawamoto, Masafumi Fukagawa · 发表于：Annals of Surgery · 年份：2002 · DOI：10.1097/00000658-200207000-00016 · 被引用次数：42 · 研究领域：Parathyroid Disorders and Treatments、Thyroid and Parathyroid Surgery、Dialysis and Renal Disease Management

SUMMARY BACKGROUND DATA: Quick intraoperative parathyroid hormone assays are widely used as a guide to the adequacy of resection during parathyroid surgery. However, some authors have reported a 15% error rate of these assays because of the presence of false-positive and false-negative results. Recently the authors have found that most commercial intact PTH (iPTH) assays cross-react with non-(1-84) PTH (likely 7-84 PTH) and that the proportional levels of non-(1-84) PTH in patients were variable in a much wider range, accounting mostly for 20% to 60% of the immunoreactivity in samples obtained from hyperparathyroid patients. A cyclase activating PTH (CAP) measured by a novel immunoradiometric assay was shown to measure specifically 1-84 PTH. Using a CAP assay, the authors studied the rate of decline of CAP after parathyroidectomy and compared it with iPTH as measured by the Nichols intact PTH immunoradiometric assay. METHODS: This study comprised 29 patients with primary hyperparathyroidism (pHPT) caused by a single adenoma and 7 patients with secondary hyperparathyroidism (secondary HPT) who underwent parathyroidectomy. Blood samples were drawn after anesthesia, before excision of one enlarged parathyroid gland in pHPT and of the last gland in secondary HPT, and at 5, 10, and 15 minutes after excision. The 7-84 PTH level was calculated by subtracting the CAP value from the iPTH value. RESULTS: The percentage of 7-84 PTH in iPTH in plasma samples was 27.5 +/- 14.4% in pHPT an...