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[Treatment of parathyroid adenomas with ethanol injection under ultrasonographic guidance]
B Vergès1, J P Cercueil, D Jacob
1Service d'endocrinologie, diabétologie et maladies métaboliques, hôpital du Bocage, centre hospitalier universitaire de Dijon, France.
Study Objective:
The objective of this retrospective study was to report the results of ethanol injection in parathyroid adenomas.
Patients And Method:
Since 1988, 31 patients with inoperable primary hyperthyroidism have been treated by ultrasound-guided percutaneous ethanol injection into the adenoma. The main surgical contraindications were heart failure (n = 12) and age over 85 years (n = 11). Plasma calcium and PTH were measured 48 hours after ethanol injection and during subsequent follow-up.
Results:
Patients had one to three ethanol injections. With a mean 5-year follow-up, total success with normal plasma calcium and PTH levels was achieved in 20 patients (64.5%), 4 of whom underwent another ethanol injection after 1 to 3 years. Partial success with correction of plasma calcium only was achieved in 9 patients (29%) resulting in an obvious clinical benefit. Failure was observed in 2 patients (6.5%) with nodular goiter, probably due to incorrect localization of the adenoma. Treatment was always well tolerated and no major side effect was observed.
Conclusion:
Ultrasound-guided percutaneous ethanol injection of parathyroid adenoma is effective in most cases of hyperparathyroidism and very useful in patients with a high surgical risk. The need for precise ultrasound localization of the adenoma is the main limitation of this treatment.