Percutaneous ethanol injection therapy: a surgery-sparing treatment for primary hyperparathyroidism (original) (raw)
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Current Concepts in the Presentation, Diagnosis and Management of Primary Hyperparathyroidism
Background: Primary hyperparathyroidism (PHPT) is a common clinical endocrine disorder. It is the most common cause of hypercalcemia in the outpatient setting. This review presents a brief summary of the new trends of presentation, diagnosis and management PHPT. Data Sources: PubMed (National Library of Medicine) articles, and Memorial Library archives of the University of Wisconsin System. Conclusions: PHPT occurs at any age, but it is most commonly seen in people over the age of 50 years and postmenopausal women. The current presentation of PHPT shifts from the classical symptomatic form to the asymptomatic form; however, parathyroidectomy is still the treatment of choice for both symptomatic and asymptomatic forms. In the past, bilateral neck exploration and intraoperative identification of all 4 parathyroid glands was the standard of treatment, nevertheless, nowadays, with the introduction of the preoperative and intraoperative localization techniques, the minimally invasive parathyroidectomy has evolved.
Background: Secondary hyperparathyroidism (SHPT) is a common complication observed in long-term dialysis patients. Its pathophysiology is mainly due to hyperphosphatemia and active vitamin D deficiency and/or resistance. This condition has a high impact on the mortality and morbidity of dialysis patients .Despite recent advances in medical therapy, surgical parathyroidectomy (PTx) is required in a considerable number of uraemic patients. Recently, other modalities of therapy, such as ultrasound-guided percutaneous parathyroid injection of ethanol have been used to treat refractory SHPT. Objective: To evaluate the efficacy of percutaneous parathyroid injection of ethanol and its impact on parathyroid function. Methods: This study had been carried out in Zagazig University Hospital. In the period from May 2007 to Dec 2008. Fifteen haemodialysis patients with severe SHPT were studied. Whom means SD serum intact PTH (i-PTH) (pg/mL), corrected serum calcium Ca (mg/dL), serum phosphate P (mg/dL) and Ca x P product (mg2/dL2) were 1294.20351.14, 10.700.22, 6.700.45, 71.33 4.68 respectively. PEIT guided by ultrasonography was performed and all glands > 0.5 cm3 were destroyed. Follow-up of the serum levels of i-PTH, corrected Ca, P and Ca x P product at one month, six month and one year was done. Results: Serum intact PTH, corrected serum Ca, serum P and Ca x P product were significantly reduced following PEIT at one month to 745.93250.96, 10.33 0.23, 5.86 0.43 and 60.65 4.43 respectively P<0.001. At the six month the serum intact PTH, corrected serum Ca, serum P and Ca x P product achieved the Kidney Disease Outcomes Quality Initiative (K/DOQI) target desired levels 310.4051.86, 10.080.11, 4.470.58, 44.8 5.7 respectively and was maintained for one year without relapse with levels 306.3349.91, 9.940.22, 4.460.59, 44.34 6.2 respectively. Conclusion: PEIT is a safe and effective treatment; it was possible to maintain one year parathyroid function within accepted levels and achieve the" K/DOQI" target desired levels of serum intact PTH, calcium , phosphorus and Ca x p product, without relapse. PEIT might decrease Ca x P product and therefore prevent calcification of the arteries in dialysis patients, and decreases cardiovascular complications in patients with severe secondary hyperparathyroidism. PEIT is to be a valid treatment choice for SHPT.
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