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1 Clinical Institute for Medical and Chemical Laboratory Diagnostics and
2 Department of Surgery (Division of General Surgery, Section of Endocrine Surgery), AKH Vienna, A1090 Vienna, Austria.
aAddress correspondence to this author at: Clinical Institute for Medical and Chemical Laboratory Diagnostics, AKH Vienna (University Hospital), Waehringerguertel 18-20, A1090 Vienna, Austria. Fax 43-1-40400-6752; e-mail christian.bieglmayer{at}univie.ac.at.
Background: Rapid intraoperative parathyroid hormone (PTH) measurements are an important prerequisite for minimally invasive parathyroidectomy, serving as a feasible marker for "cure" because of the short half-life of PTH. Because automated analysis may facilitate monitoring, two automated PTH assays were compared with an established manual method.
Methods: We collected 109 plasma samples during minimally invasive surgery on 20 patients with primary hyperparathyroidism and single-gland disease. PTH was analyzed manually with a test from Nichols and by two automated assays from Diagnostic Product Corporation (DPC) and Roche, respectively. PTH half-life and residual concentrations were calculated by two kinetic models.
Results: Despite good overall correlations between methods [DPC = 1.07(Nichols) - 12 ng/L; r = 0.95, Sy|x = 26 ng/L and Roche = 1.16(Nichols) - 2.82 ng/L; r = 0.98; Sy|x = 16 ng/L], marked interindividual differences were observed. The iterative kinetic model failed with a nonuniform PTH decrease, but the interpolative model produced valid results. The mean (SD) half-life of 3.7 ± 1.4 min with DPC differed significantly (P <0.05) from the 4.3 ± 1.6 min with Roche (Nichols, 4.0 ± 1.6 min). DPC produced significantly lower mean residual PTH (15 ng/L) vs Roche (27 ng/L); Nichols results were between them (20 ng/L). However, these differences were clinically irrelevant.
Conclusions: Automated methods are as suitable as the manual test. The preoperative baseline PTH is necessary but is insufficient for kinetic calculations.
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  A. K. Abraham, D. E. Mager, X. Gao, M. Li, D. R. Healy, and T. S. Maurer Mechanism-Based Pharmacokinetic/Pharmacodynamic Model of Parathyroid Hormone-Calcium Homeostasis in Rats and Humans J. Pharmacol. Exp. Ther., July 1, 2009; 330(1): 169 - 178. [Abstract] [Full Text] [PDF]
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 L. M. Henrich, A. D. Rogol, P. D'Amour, M. A. Levine, J. B. Hanks, and D. E. Bruns Persistent Hypercalcemia After Parathyroidectomy in an Adolescent and Effect of Treatment With Cinacalcet HCl Clin. Chem., December 1, 2006; 52(12): 2286 - 2293. [Abstract] [Full Text] [PDF]
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C. Bieglmayer, K. Kaczirek, G. Prager, and B. Niederle Parathyroid Hormone Monitoring during Total Parathyroidectomy for Renal Hyperparathyroidism: Pilot Study of the Impact of Renal Function and Assay Specificity Clin. Chem., June 1, 2006; 52(6): 1112 - 1119. [Abstract] [Full Text] [PDF]
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 K. Kaczirek, G. Prager, P. Riss, G. Wunderer, R. Asari, C. Scheuba, C. Bieglmayer, and B. Niederle Novel parathyroid hormone (1-84) assay as basis for parathyroid hormone monitoring in renal hyperparathyroidism. Arch Surg, February 1, 2006; 141(2): 129 - 134. [Abstract] [Full Text] [PDF]
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