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Intraoperative Parathormonbestimmung beim primären Hyperparathyreoidismus

Intraoperative parathyroid hormone determination for primary hyperparathyroidism

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Zusammenfassung

Die intraoperative Parathormonschnellbestimmung (IOPTH) hat vor allem zur weiten Verbreitung der fokussierten und minimal-invasiven Operationsverfahren beim primären Hyperparathyreoidismus beigetragen. Durch die IOPTH-Bestimmung lässt sich mit hoher Sicherheit zum Zeitpunkt der Operation eine vorliegende Mehrdrüsenerkrankung ausschließen, ohne dass alle vier Nebenschilddrüsen dargestellt werden müssen. Dabei ist für die Prognose des operativen Erfolgs („biochemische Heilung“) die Wahl des Cut-off-Wertes der IOPTH-Bestimmung, das sogenannte Erfolgskriterium, entscheidend. Die Vorzüge und Einschränkungen der vielen beschriebenen Erfolgskriterien sind unübersichtlich und werden zudem unterschiedlich bewertet. Insbesondere unter Kosten-Nutzen-Aspekten wird die standardmäßige Anwendung der IOPTH-Bestimmung als „biochemischer Schnellschnitt“, auch bei der konventionellen Parathyreoidektomie, kontrovers diskutiert. Im vorliegenden Beitrag soll der aktuelle Kenntnisstand zur IOPTH-Bestimmung und eine praxisrelevante Empfehlung zum klinischen Einsatz der Methode gegeben werden.

Abstract

Intraoperative parathyroid hormone measurement (IOPTH) has proved to be an important promoter for focused and minimally invasive parathyroidectomy procedures in primary hyperparathyroidism. IOPTH enables multiglandular disease to be excluded with a high degree of certainty at the time of operation. The choice of the cut-off value for IOPTH as the criterion for success is of utmost importance with respect to the prognosis for operative success (biochemical healing). Advantages and disadvantages of the variety of existing IOPTH success criteria are confusing and their assessment is contradictory. Particularly with respect to cost-benefit aspects the standard application of IOPTH as „biochemical frozen section“ even in conventional open parathyroidectomy remains a matter of controversy. This article gives an up-date on current knowledge and provides practical guidelines for clinical use of IOPTH.

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  1. Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Halle (Saale), Medizinische Fakultät, Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle/Saale, Deutschland

    K. Lorenz & H. Dralle

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  1. K. Lorenz
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  2. H. Dralle
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Correspondence to K. Lorenz.

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Lorenz, K., Dralle, H. Intraoperative Parathormonbestimmung beim primären Hyperparathyreoidismus. Chirurg 81, 636–642 (2010). https://doi.org/10.1007/s00104-009-1885-7

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