Nephrology Dialysis Transplantation, Vol 13, Issue 12 3111-3117, Copyright © 1998 by Oxford University Press
S Fletcher, N Kanagasundaram, H Rayner, H Irving, R Fowler, A Brownjohn, J Turney, E Will and A Davison
Background. Tertiary hyperparathyroidism continues to
cause significant morbidity in patients with chronic renal failure. This is
frequently resistant to medical management and may ultimately require a
surgical parathyroidectomy. Recent studies have reported upon the technique
of percutaneous ethanol ablation for both primary and tertiary
hyperparathyroidism. In this study we report on a 5 year experience using
ethanol injection and compare the results with surgical parathyroidectomy.
Methods. A prospective study in 39 patients with
tertiary hyperparathyroidism, 25 were dialysis dependent and 14 had a
functioning renal allograft. Twenty-two patients underwent percutaneous
fine needle ethanol injection (PFNEI) and 17 underwent surgical
parathyroidectomy. Results. A >30% reduction in
intact parathyroid hormone (iPTH) was achieved in 11 of 22 patients
undergoing PFNEI after a mean of 1.8±1.4 injections per gland.
In four patients, symptomatic hyperparathyroidism recurred and they
required further PFNEI or surgical parathyroidectomy at 17, 28, 46, and 48
months later. There was no significant reduction in iPTH in 11 patients
following PFNEI after a mean of 2.5±1.3 injections per gland.
They all required a subsequent surgical parathyroidectomy for symptomatic
hyperparathyroidism. Four patients developed a laryngeal nerve palsy
following PFNEI, two of which were permanent. Seventeen patients underwent
successful surgical parathyroidectomy as a primary procedure.
Conclusion. Whilst PFNEI is successful in primary
hyperparathyroidism, when typically only one adenoma is present, the
effectiveness of PFNEI is unpredictable and the long term results are poor
compared with those of surgical parathyroidectomy in tertiary
hyperparathyroidism. The procedure is not without complications and makes
subsequent surgery more difficult. Therefore it can only be recommended for
patients with a known single parathyroid gland such as patients in whom
hyperparathyroidism has recurred following a previous surgical subtotal
parathyroidectomy and who are unsuitable for further surgery.
Keywords: chemical parathyroidectomy; percutaneous
fine needle ethanol injection; tertiary hyperparathyroidism
ORIGINAL ARTICLES
Assessment of ultrasound guided percutaneous ethanol injection and parathyroidectomy in patients with tertiary hyperparathyroidism
Renal Unit, Leeds General Infirmary, Great George Street, Leeds, UK; Department of Renal Medicine, St James's University Hospital, Beckett Street, Leeds, UKCorresponding author address: Renal Unit, Walsgrave Hospitals NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
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