T Tai and DR Maceri*
Department of Otolaryngology – Head and Neck Surgery, Keck School of Medicine of USC, 1975 Zonal Ave, Los Angeles, CA 90033, USAFulltext PDF
One- hundred-and-fifteen patients underwent neck exploration for hyperparathyroidism at the Keck School of Medicine, University of Southern California. Twenty-seven of these patients had intraoperative parathyroid hormone levels drawn simultaneously from both internal jugular veins and received a definitive diagnosis of their disease based on tissue pathology. This majority of these diagnoses were comprised of parathyroid adenomas or multiglandular (four-gland) hyperplasia. From this cohort, thirteen cases had parathyroid abnormalities that could not be localized by technectium-99 sestamibi scan, while six patients received imaging results that conflicted between sestamibi scan and high resolution neck ultrasonography or sestamibi scan and 4D CT scan. By utilizing the split venous sampling technique, we demonstrate that the hormone gradient between the left and right internal jugular veins is a statistically valid predictor of the side and the etiology of a parathyroid abnormality. This holds true even in instances where patients receive non-localizing or conflicting preoperative imaging results. The accuracy of this technique improves dramatically as the absolute value of the gradient exceeds 100 pg/ml. Split vein parathyroid hormone sampling is a useful adjunct in guiding parathyroid surgery when conventional imaging modalities are inadequate. Application of this technique provides the surgeon a greater degree of assurance that a minimally invasive approach will result in an appropriate cure.
T Tai, DR Maceri. Split Central Venous Sampling of Parathyroid Hormone in Non-localizing Parathyroid Tumors. Clin Surg. 2017; 2: 1647.