Treatment of refractory secondary hyperparathyroidism with ethanol injection: The importance of glandular volume

Douthat, Walter; Orozco, Santiago; Arteaga, Javier de; Massari, P.

doi:10.1046/j.1523-1755.63.s85.24.x

Cited by 17 publications

(15 citation statements)

References 19 publications

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“…This differs from reports published by other authors, who have shown a better response in patients with higher PTH levels and larger glandular volumes [18]. …”

Section: Discussioncontrasting

confidence: 99%

Treatment of Uremic Hyperparathyroidism with Percutaneous Ethanol Injection

Fassi

Lambertini²,

Farias³

et al. 2005

Nephron Clin Pract

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The percutaneous ethanol injection (PEI) with ultrasound guidance has been suggested for the treatment of patients with hyperparathyroidism who are on dialysis, with the aim of selectively treating the parathyroid glands with nodular hyperplasia. We present our experience in 25 patients with chronic renal failure followed during 13.4 ± 10.6 months. A decrease in the levels of parathormone (PTH) (1,236.32 ± 129.8 vs. 721.66 ± 142.24 pg/ml), phosphatemia (6.16 ± 0.35 vs. 4.93 ± 0.36 mg/dl) and calcium-phosphorous product (60.82 ± 3.81 vs. 46.47 ± 3.46 mg²/dl²) was verified. In 56% of patients, PTH levels decreased (>50% of the baseline value) and 36% had final values <300 pg/ml. Patients in whom ultrasound showed a single gland responded better than those with more than one gland (83.3 vs. 30.8% of responders in each group). The procedures performed had a 4.9% complication rate: hematoma, symptomatic hypocalcemia, temporary paresis of the vocal cords. In summary, treatment with PEI is useful for the management of patients with hyperparathyroidism who are on dialysis, and the results achieved are better in patients who have a single gland identified by ultrasonography.

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“…This differs from reports published by other authors, who have shown a better response in patients with higher PTH levels and larger glandular volumes [18]. …”

Section: Discussioncontrasting

confidence: 99%

Treatment of Uremic Hyperparathyroidism with Percutaneous Ethanol Injection

Fassi

Lambertini²,

Farias³

et al. 2005

Nephron Clin Pract

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“…Multivariate logistic regression analysis revealed that the efficacy of cinacalcet on SHPT was significantly associated with the number of enlarged PTGs. Ultrasonographic examination of PTGs, the estimated glandular volume, and the number of enlarged PTGs, has been demonstrated to be informative for predicting a therapeutic response to active vitamin D sterols among patients with advanced SHPT [22][23][24][25]. When the estimated glandular volume exceeds 500 mm 3 or the largest diameter exceeds 10 mm by ultrasonography, the PTG seems to contain nodular hyperplastic lesions [26][27][28].…”

Section: Discussionmentioning

confidence: 99%

Number of enlarged parathyroid glands might be a predictor of cinacalcet response in advanced secondary hyperparathyroidism

et al. 2011

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“…In determining responsiveness to the treatment gland size is an important factor [17]. Patients with at least one gland greater than 0.5 cm 3 or 1 cm in diameter are usually refractory to medical therapy [18,19]. Patients selected by sonography benefit from surgical parathyroidectomy or parathyroid intervention [2,4,[18][19][20][21].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with at least one gland greater than 0.5 cm 3 or 1 cm in diameter are usually refractory to medical therapy [18,19]. Patients selected by sonography benefit from surgical parathyroidectomy or parathyroid intervention [2,4,[18][19][20][21]. Unlike the primary hyperparathyroidism, the glandular enlargement in ESRD tends to involve more than one gland and the gland size is directly related to increased iPTH secretion [17,22].…”

Section: Discussionmentioning

confidence: 99%

Assessment of parathyroid glands in hemodialysis patients by using color Doppler sonography

Özcan

Oktay²

2009

Eur Radiol

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The aim of this study was to assess the role of color and spectral Doppler ultrasound (CDU) in the evaluation of enlarged parathyroid glands in hemodialysis patients with secondary hyperparathyroidism. Fourteen hemodialysis patients with elevated intact parathyroid hormone (iPTH) levels were evaluated prospectively with CDU. The volume of each observed parathyroid gland and the spectral CDU data (velocities, resistance and pulsatility indices, systolic to diastolic ratio, and flow volume output (FVO)) were noted. The biochemical data (iPTH, calcium, phosphate levels), and CDU results were analyzed with the Spearman correlation test. Two patients were excluded, and 27 enlarged parathyroid glands were observed in 12 patients. The mean total volume of enlarged parathyroid glands per patient was 1.95 cm(3) (0.06-5.5 cm(3)). Arterial supply was demonstrated in 78% (21/27) of enlarged parathyroid glands. Mean total FVO of enlarged glands per patient was 238.5 ml/min (620-0 ml/min) and mean iPTH level was 1,477 pg/ml (643-3,132 pg/ml). The positive correlations of total volume (p = 0.022), iPTH (p = 0.024), and FVO (p = 0.022) were statistically significant. In secondary hyperparathyroidism, total volume of the visualized enlarged parathyroid glands and the total of FVOs per patient are positively correlated with iPTH levels which may help clinical management and follow-up of end-stage renal disease patients.

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Treatment of refractory secondary hyperparathyroidism with ethanol injection: The importance of glandular volume

Abstract: Our findings suggest that patients with uncontrolled secondary hyperparathyroidism may benefit from PEIT if they present with very high basal PTH levels and/or big nodule size.

Cited by 17 publications

References 19 publications

Treatment of Uremic Hyperparathyroidism with Percutaneous Ethanol Injection

Treatment of Uremic Hyperparathyroidism with Percutaneous Ethanol Injection

Number of enlarged parathyroid glands might be a predictor of cinacalcet response in advanced secondary hyperparathyroidism

Assessment of parathyroid glands in hemodialysis patients by using color Doppler sonography

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