Diaz-Aguirregoitia et al monitored total serum calcium during surgery for removal of parathyroid adenomas. This can help document complete removal of adenomatous disease without the need for measuring parathyroid hormone levels. The authors are from the Basque Country University in San Sebastian and several hospitals in northern Spain.



(1) Measure serum total calcium prior to surgery.

(2) Measure serum total calcium every 5 minutes after removal of an adenoma.



• If the adenoma is completely removed the first 5 minute total serum calcium level will be within the normal limit.

• If in doubt the serum calcium will continue to drop at 10, 15 and 20 minutes after adenoma removal then will level off.



The authors found this method was cheaper and faster than performing serum parathyroid hormone determinations with comparable findings.

• The method can complement measurements of parathyroid hormone if there is any clinical uncertainty.



• The serum calcium prior to surgery should be above the upper limit of the normal reference range.

The analytical method for measuring total calcium should be accurate and reliable. If the method has a high coefficient of variation then the difference in calcium levels could just be normal method variability.


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