title: A case of post-transplant hyperparathyroidism treated with ethanol injection.
abstract: A 15-year-old boy with chronic renal failure secondary to Alport's syndrome underwent living-related renal transplantation from his 48-year-old father. His primary immunosuppressive regimen was composed of tacrolimus, mizolibine, and methylprednisolone. The postoperative course was satisfactory with one episode of mild acute rejection, treated successfully with methylprednisolone pulse therapy. Two months later, hypercalcemia (11.8-13.2 mg/dl) and hypophosphatemia (2.5-3.0 mg/dl) were noted without any bone symptoms. The serum intact-parathyroid hormone (PTH) and serum alkaline phosphatase levels were 240 pg/ml and 2483 IU/l, respectively. Ultrasound studies revealed enlargement of the two parathyroid glands. Under the diagnosis of tertiary hyperparathyroidism, he underwent percutaneous ethanol injection (PEIT) into the left parathyroid gland. Although levels of serum calcium and phosphorus returned to normal ranges and the intact PTH level decreased to 95 pg/ml with the three injections, another injection was needed to normalize recurrent hypercalcemia 2 months later. The patient experienced only transient mild dysphonia and local pain after PEIT. Although PEIT is believed less effective than parathyroidectomy, it has some advantages such as applicability to high-risk patients, repeatability of treatment, low incidence and severity of side effects.
authors.affiliation: Department of Pediatrics, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Minami-ku, Hiroshima 734-8530, Japan. ohtaotachan1@aol.com
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Ohta
authors.forename: Takashi
authors.initials: T
authors.lastname: Sakano
authors.forename: Shohei
authors.initials: S
authors.lastname: Fuchinoue
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Tsuji
authors.forename: Kazunari
authors.initials: K
authors.lastname: Tanabe
authors.forename: Motoshi
authors.initials: M
authors.lastname: Hattori
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nagafuchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shiraga
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Kihara
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kinoshita
authors.forename: Katsumi
authors.initials: K
authors.lastname: Ito
mesh_terms: D000279:Administration, Cutaneous; D000293:Adolescent; D000431:Ethanol / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D006961:Hyperparathyroidism / Q000188:drug therapy* / Q000209:etiology*; D007267:Injections; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D010280:Parathyroid Glands
chemical_list: D000431:Ethanol