In primary hyperparathyroidism due to a single adenoma, which intraoperative strategy has been validated to confirm adequate resection and predict operative success?
- A Intraoperative PTH drop >50% from baseline at 10 minutes post-excision (Miami criterion) ✓
- B Four-gland exploration until two normal glands are confirmed
- C Intraoperative calcium level normalisation
- D Frozen section confirming parathyroid tissue
Correct answer: A. Intraoperative PTH drop >50% from baseline at 10 minutes post-excision (Miami criterion)
Explanation
The Miami criterion states that a >50% drop in intact PTH at 10 minutes after adenoma excision (from the highest pre-excision value) predicts cure with >95% accuracy. This criterion enables focused/minimally invasive parathyroidectomy without four-gland exploration. If PTH does not fall adequately, multiglandular disease is suspected and bilateral exploration is undertaken.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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