title: Chemical parathyroidectomy for recurrence of secondary hyperparathyroidism.
abstract: To avoid the risks of reoperation, we treated 15 uremic patients on regular extracorporeal dialysis and affected by hyperparathyroidism recurring after subtotal parathyroidectomy with ultrasound-guided ethanol injection. Follow-up was extended to 12 months after the last injection and for 11 patients to 24 months. Plasma parathyroid hormone concentration, as measured with a carboxyterminal parathyroid hormone (c-PTH) radioimmunoassay (normal, 0.2 to 2 ng/mL), significantly decreased from a basal value of 19.29 +/- 14.73 ng/mL to 11.19 +/- 9.54 ng/mL at 1 month, 7.45 +/- 4.99 ng/mL at 6 months, 6.91 +/- 4.71 ng/mL at 12 months, and 6.51 +/- 3.89 ng/mL at 24 months. Total and bone alkaline phosphatase decreased in parallel. The only remarkable side effect was transient dysphonia, which occurred in two cases. These data suggest that the technique of ultrasound-guided fine-needle ethanol injection might be a valuable alternative to surgery for recurrent hyperparathyroidism after subtotal parathyroidectomy in selected patients. This should be confirmed in larger series of patients and with a more prolonged follow-up.
authors.affiliation: Divisione di Nefrologia e Dialisi, Ospedale Generale Provinciale, Busto Arsizio, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Giangrande
authors.forename: A
authors.initials: A
authors.lastname: Castiglioni
authors.forename: L
authors.initials: L
authors.lastname: Solbiati
authors.forename: E
authors.initials: E
authors.lastname: Ballarati
authors.forename: F
authors.initials: F
authors.lastname: Caligara
mesh_terms: D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000378:metabolism; D000431:Ethanol / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000201:enzymology; D007267:Injections / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000431:Ethanol; D000469:Alkaline Phosphatase