Ultrasound-guided Percutaneous Ethanol Ablation of Parathyroid Hyperplasia: Preliminary Experience in Patients on Chronic Dialysis

Abstract

Objective: We report on a 3-year experience using single-shot, ultrasonography-guided, percutaneous ethanol ablation (PEA) of hyperplastic parathyroid glands in chronic dialysis patients suffering from secondary or tertiary hyperparathyroidism. Materials and Methods: Seventeen uraemic patients (mean age 52 ± 14 years) with hypercalcaemia and elevated serum levels of parathyroid hormone were assessed for ethanol ablation. Ten patients did not fulfil the inclusion criteria and underwent surgical parathyroidectomy. Seven patients were treated using PEA. Results: All patients treated with PEA tolerated the procedure well, and no major complications were observed. Three out of seven patients underwent further ethanol ablation due to recurrent symptomatic hyperparathyroidism. Following the procedures, serum values of total calcium and parathyroid hormone remained within target range with concomitant medical therapy in all patients. Conclusion: PEA performed as a single-shot therapy can be used as a minimally invasive and safe supplement to medical therapy in the treatment of secondary or tertiary hyperparathyroidism in selected patients. In case of recurrence, treatment can be repeated without any problems.

Zusammenfassung

Studienziel: Wir berichten über unsere dreijährige Erfahrung mit ultraschallgezielter perkutaner Ethanolablation (PEA) der Nebenschilddrüse bei chronisch dialysepflichtigen Patienten, die an sekundärem oder tertiärem Hyperparathyroidismus leiden. Patienten/Methode: Siebzehn dialysepflichtige Patienten (Alter 52 ± 14 Jahre) mit Hyperkalzämie und erhöhten Parathormonwerten wurden für eine Ethanolablation vorgestellt. Davon erfüllten zehn Patienten die Einschlusskriterien nicht und wurden chirurgisch parathyroidektomiert. Sieben Patienten wurden mittels PEA behandelt. Resultate: Die PEA wurde von allen Patienten gut toleriert. Drei von sieben Patienten wurden aufgrund eines persistierenden symptomatischen Hyperparathyroidismus einer weiteren Ethanolablation unterzogen. Nach dem Eingriff lagen die Laborwerte von Serum-Kalzium und intaktem Parathormon bei allen Patienten mit entsprechender medikamentöser Therapie im Referenzbereich. Schlussfolgerung: Die PEA als Single-Shot-Therapie stellt bei Patienten mit sekundärem oder tertiärem Hyperparathyroidismus eine minimalinvasive und komplikationsarme Zusatzbehandlung zur medikamentösen Therapie dar. Im Falle eines Rezidivs ist eine neuerliche Behandlung einfach durchführbar.

Key words

Hyperparathyroidism - ethanol ablation - ultrasonography - interventional therapy

Schlüsselwörter

Hyperparathyroidismus - Ethanolablation - Ultraschall - interventionelle Therapie

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