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Arteriographic ablation of cervical parathyroid adenomas
J A Pallotta1, B A Sacks, D E Moller
1Charles A. Dana Research Institute, Beth Israel Hospital, Boston, Massachusetts 02215.
Abstract:
In some cases of primary hyperparathyroidism, in particular where neck exploration has been unsuccessful, an alternative to surgical therapy may be desirable. We studied the acute and chronic metabolic effects of attempted angiographic destruction by angiographic contrast infusion of solitary parathyroid adenomas in 18 patients with symptomatic disease. Fourteen patients had failed prior surgery; 4 patients had not undergone prior surgery but were extremely high surgical risks. Cervical adenomas were present in 17 of 18 subjects; mediastinal adenoma in 1 of 18. Sixteen patients underwent selective parathyroid venous catheterization, which facilitated subsequent arteriographic localization. Selective arteriographic localization and attempted angiographic ablation were performed in all subjects with standard contrast, renografin-60. Laboratory studies, including serum calcium and PTH, were frequently performed before and after attempted angiographic parathyroid ablation. In all patients serum calcium fell to normal or subnormal levels within 48 h of attempted ablation. Prolonged follow-up (mean, 35.1 months) revealed that ablation was curative in 12 of 18 (sustained normocalcemia) and partially effective in 1 of 18 patients. For the entire group serum calcium fell from 3.14 +/- 0.07 at presentation to 2.42 +/- 0.07 mmol/L at the end of follow-up (or before surgery in unsuccessful cases; P less than 0.001). In 4 of 5 failed cases hypercalcemia recurred within 2 weeks. All 5 failed cases underwent curative surgery, aided by accurate localization achieved during angiographic procedure. Several transient complications and 1 case of permanent hypoparathyroidism were noted. We conclude that angiographic ablation of cervical parathyroid adenomas can be considered as an extension of diagnostic angiographic procedures in selected cases of primary hyperparathyroidism who have failed prior surgery of possibly in rare cases where surgery is contraindicated.
Insights
Angiographic ablation using contrast infusion offers a minimally invasive option for treating primary hyperparathyroidism, especially after failed surgery. This procedure effectively lowered serum calcium levels in most patients, with a significant cure rate.
Area of Science:
- Endocrinology
- Interventional Radiology
- Nephrology
Background:
- Primary hyperparathyroidism (PHPT) often requires surgical intervention.
- Neck exploration may be unsuccessful in some PHPT cases.
- Alternative treatments are sought for patients with failed prior surgery or high surgical risk.
Purpose of the Study:
- To evaluate the efficacy and safety of angiographic ablation for solitary parathyroid adenomas.
- To assess the acute and chronic metabolic effects of this interventional procedure.
- To determine its utility in patients with symptomatic PHPT.
Main Methods:
- Eighteen patients with symptomatic PHPT underwent attempted angiographic ablation of parathyroid adenomas using contrast infusion.
- Fourteen patients had prior unsuccessful neck surgery; 4 were high surgical risks.
- Selective parathyroid venous catheterization and arteriographic localization were performed, followed by ablation with Renografin-60.
Main Results:
- Serum calcium normalized or became subnormal within 48 hours in all patients post-ablation.
- Ablation was curative in 12 of 18 patients (sustained normocalcemia) and partially effective in 1.
- Mean follow-up was 35.1 months; serum calcium significantly decreased (P < 0.001).
Conclusions:
- Angiographic ablation is a viable alternative for PHPT in selected patients, particularly those with failed prior surgery or contraindications to surgery.
- The procedure facilitated accurate localization for subsequent curative surgery in cases of failure.
- While generally safe, potential complications include transient issues and permanent hypoparathyroidism.