Long-term follow-up of patients with hyperparathyroidism treated by transcatheter staining with contrast agent

Primary hyperparathyroidism is generally treated by primary neck exploration. Particularly in patients with hyperparathyroidism caused by adenoma, cervical exploration is generally curative, and extensive preoperative localization studies are unnecessary. If, after thorough primary cervical exploration, no adenoma is identified or at least four parathyroid glands are not confirmed and the patient's hypercalcemia persists, radiologic localization studies are indicated prior to a repeat operation. Persistent hypercalcemia in defined as the failure of calcium levels to return to normal soon after parathyroid exploration; recurrent hyperparathyroidism is defined as hypercalcemia that follows 6 months of low or normal serum calcium levels. Persistent or recurrent hypercalcemia not controlled by a primary cervical exploration may be due to an ectopic parathyroid adenoma, either outside the usual anatomic sites in the neck or in the mediastinum. Techniques used for localization of these ectopic adenomas include sonography, computed tomography scanning, venous sampling, digital angiography, and selective arteriography. Of these techniques, selective arteriography not only has been precise but also offers the possibility of therapy. A small group of patients who underwent embolization of ectopic parathyroid adenomas through the angiographic catheter was reviewed 6 years ago with the cautious suggestion that this technique, under highly specialized indications, might offer a percutaneous treatment of hyperparathyroidism in selected patients. Since the time of the preliminary report, radiologic techniques have been modified, indications for patient selection have been refined, and experience with this method of managing persistent hyperparathyroidism has increased. It is the purpose of this report to summarize this experience with long-term follow-up of those patients treated by transcatheter staining.