Clinical guidelines and PTH measurement: does assay generation matter?

Clinical guidelines and PTH measurement: does assay generation matter? Endocr Rev. 2019 May 13;: Authors: Smit MA, van Kinschot CMJ, van der Linden J, van Noord C, Kos S Abstract Parathyroid hormone (PTH) is an important regulator of calcium and phosphate homeostasis and bone remodeling. PTH is metabolized into PTH fragments which are measured to a different extent by PTH assays of different generations. This is due to differences in fragments recognized and lack of assay standardization. PTH is measured in the workup of several conditions and clinical guidelines provide recommendations concerning these measurements. This review provides an overview of the impact of differences between PTH assays, when applying distinct clinical guidelines for primary and secondary hyperparathyroidism and perioperative use of PTH measurements. Guidelines deal with PTH measurement in different ways, recommending either trend monitoring, the use of a fold-increase of the upper reference limit, or state an absolute PTH cut-off value. For classic primary hyperparathyroidism (PHPT) the type of PTH assay used will not affect diagnosis or management as the precise concentration of PTH is less relevant. In chronic kidney disease (CKD), the guideline recommends treatment of secondary hyperparathyroidism (SHPT) above a 2-9-fold PTH increase, which will result in different clinical decisions, dependent on the assay used. For patients after bariatric surgery gui...
Source: Endocrine Reviews - Category: Endocrinology Tags: Endocr Rev Source Type: research