Use of Percutaneous Ethanol Injection Therapy for Recurrent Secondary Hyperparathyroidism after Subtotal Parathyroidectomy

Abstract

We evaluated the efficacy of percutaneous ethanol injection therapy (PEIT) as a therapeutic option for recurrence of secondary hyperparathyroidism after subtotal parathyroidectomy in ESRD patients. Six patients underwent PEIT. A mean of 1.3 ± 0.8 ethanol injections was performed. Nodular volume was 1.5 ± 1.7 cm3, and 2.8 ± 2.8 cm3 of ethanol was injected per patient. After ethanol injection PTH decreased significantly (1897 ± 754 to 549 ± 863 pg/mL (P < .01)). There was also a reduction in serum calcium, phosphorus and calcium-phosphorus product. A positive and significant correlation was found between nodular volume with ethanol injected and time from parathyroidectomy. Only one patient required hospitalization due to severe hypocalcaemia. In other two cases, local discomfort and temporary mild dysphonia were registered. PEIT is an effective treatment to control recurrences of secondary hyperparathyroidism postsubtotal parathyroidectomy.

Advances in pharmacotherapy for secondary hyperparathyroidism

“…Ethanol injection also represents a reasonable option in cases of persistence of SHPT after PTx. In patients with persistent hyperparathyroidism after subtotal PTx and PTH above 300 pg/ml, ethanol injection decreased PTH levels to the desirable range [107]. In another study performed by Chen et al, patients were distributed into a recurrent group and a persistent group.…”

Feasibility and safety of ultrasound-guided percutaneous microwave ablation for tertiary hyperparathyroidism

“…In recent years, various percutaneous ablation techniques have been developed to treat patients with hyperparathyroidism, such as ethanol or acetic acid injection [16][17][18], laser ablation [19], high-intensity focused ultrasound treatment [20], radiofrequency ablation [21] and microwave ablation (MWA) [22]. More recently, studies have reported MWA as a successful effective nonsurgical alternative for treating SHPT [23,24].…”

Hyperparathyroidism caused by distant pulmonary lesions and parathyromatosis after ethanol injection/parathyroidectomy for secondary hyperparathyroidism

“…When secondary renal hyperparathyroidism (SHPT) is advanced and nonresponsive to medical treatment, invasive interventional therapy, such as percutaneous ethanol injection therapy (PEIT) and parathyroidectomy, is required for management. PEIT can sometimes be effective in SHPT cases, particularly in patients who have fewer swollen parathyroid glands . The number of punctures during PEIT should be limited because each puncture causes injury to the capsule of a hyperplastic parathyroid gland; in addition, reports have shown that this procedure is ineffective in patients with multiple swollen parathyroid glands .…”

“…PEIT can sometimes be effective in SHPT cases, particularly in patients who have fewer swollen parathyroid glands. [4][5][6] The number of punctures during PEIT should be limited because each puncture causes injury to the capsule of a hyperplastic parathyroid gland; in addition, reports have shown that this procedure is ineffective in patients with multiple swollen parathyroid glands. 4,5 In parathyromatosis, multiple foci of benign hyperfunctioning parathyroid tissue are present in the neck or mediastinum, [7][8][9] and this complication causes persistent hyperparathyroidism in SHPT.…”