Tertiary hyperparathyroidism treated by ultrasonically guided percutaneous fine-needle ethanol injection

Area of Science:

• Nephrology
• Endocrinology
• Interventional Radiology

Background:

• Advanced renal failure frequently leads to secondary and tertiary hyperparathyroidism.
• Tertiary hyperparathyroidism necessitates reducing parathyroid gland mass.
• Existing treatments often involve surgical parathyroidectomy.

Purpose of the Study:

• To evaluate the efficacy of percutaneous ethanol injection in treating enlarged parathyroid nodules in uremic patients with tertiary hyperparathyroidism.
• To assess the impact of ethanol injection on serum calcium, parathyroid hormone levels, and patient symptoms.

Main Methods:

• Percutaneous ethanol injection was administered to enlarged parathyroid nodules in 9 uremic patients.
• Patients presented with hypercalcemia, elevated parathyroid hormone, and ultrasonically detected enlarged glands.
• Treatment response was monitored over 18 months.

Main Results:

• Six out of nine patients responded to ethanol injection treatment.
• In responders, serum calcium and ionized calcium normalized.
• Parathyroid hormone levels decreased by at least 30% in responders, with symptom improvement observed in seven patients. No complications were reported.

Conclusions:

• Percutaneous ethanol injection serves as a viable alternative to parathyroidectomy for managing tertiary hyperparathyroidism in select uremic patients.
• The procedure demonstrated effectiveness in normalizing biochemical parameters and improving clinical symptoms.
• This minimally invasive approach offers a potentially safer option for parathyroid gland mass reduction.