Tertiary Hyperparathyroidism Treated by Ultrasonically Guided Percutaneous Fine-Needle Ethanol Injection

Abstract

Advanced renal failure is often accompanied by secondary and tertiary hyperparathyroidism. In tertiary hyperparathyroidism it is necessary to reduce the gland mass. The present study describes the response to treatment with percutanous injection of ethanol of enlarged parathyroid nodules in 9 uremic patients. All had hypercalcemia, severely elevated serum levels of parathyroid hormone and ultrasonically detectable enlarged parathyroid glands. Three patients did not respond to the treatment. In the remaining 6 patients, serum values of total and ionized calcium were normalized and the serum values of parathyroid hormone were reduced at least 30% after 18 months. Seven of the patients experienced an improvement of symptoms. No complications were seen. We conclude that treatment with ethanol injection can be used as an alternative to conventional parathyroidectomy to improve parathyroid status in selected patients.

Severe Hyperparathyroidism with Hypercalcemia Associated with Chronic Renal Failure at Pre-Dialysis State.

“…In addition, the absence of nephrolithiasis, the presence of a high level of serum phosphate (9.9 mg/dl) as compared with mild hypercalcemia, accelerated ectopic calcification which is common in secondary hyperparathyroidism, severe normocytic anemia with a low level of erythropoietin, and severe hyperplastic changes in all four parathyroid glands favor concluding that the patient initially had chronic renal failure which then induced severe secondary hyperparathyroidism. The presence of hypercalcemia supports the view that the patient might have developed tertiary hyperparathyroidism [10][11][12]. As mentioned above, the hyperparathyroidism observed in the present case most likely was secondary to chronic renal failure.…”

Subtotal parathyroidectomy with thymectomy for autonomous hyperparathyroidism after renal transplantation

“…Various treatment modalities have been proposed for tertiary HPT after failure of conservative medical management. These treatments can be broadly divided into systematic subtotal parathyroid reduction surgery (total parathyroidectomy with thymectomy and autotransplantation, or subtotal parathyroidectomy with thymectomy), regardless of preoperative and intraoperative findings, as classically indicated in secondary HPT7, 8, 11, and a more conservative approach, tailored to the macroscopically (or ultrasonographically) enlarged glands12, 13, 18. Surgical series using these various approaches have all reported long‐term success rates greater than 70 per cent, although different criteria were used to define postoperative hypoparathyroidism and recurrent HPT7, 12, 13, 19–23.…”

Accuracy of intra-operative PTH measurement during subtotal parathyroidectomy for tertiary hyperparathyroidism after renal transplantation

“…When hypercalcemia persists for more than 1 year after kidney transplantation or when patients develop complication related to hyperparathyroidism, parathyroidectomy is currently the only available curative treatment. The standard surgical approach for patients with tertiary hyperparathyroidism is subtotal parathyroidectomy or total parathyroidectomy with autotransplantation [1][2][3][4][5][6][7]; however, some authors have advocated a less-than-subtotal resection in some patients, describing up to one third of their patients with limited gland involvement (single or double 'adenoma') [8][9][10][11]. Because it is sometimes difficult to find all parathyroid glands, particularly when patients have more than four glands, and to leave a remnant of adequate size (big enough to avoid hypoparathyroidism but small enough to avoid persistent and recurrent disease), it would be helpful to have a reliable intra-operative indicator of cure.…”