title: Efficacy of direct injection of calcitriol into the parathyroid glands in uraemic patients with moderate to severe secondary hyperparathyroidism.
abstract: BACKGROUND
  Secondary hyperparathyroidism (2HPT) is a common complication in uraemic patients. When medical therapy, including high doses of intravenous calcitriol, fails to suppress the pathological secretion of parathyroid hormone (PTH), one of the newly developed interventional techniques, such as percutaneous ethanol injection therapy (PEIT), is an option before taking the surgical solution. A protocol for direct calcitriol injection therapy and a discussion of its effectiveness and limitations for an enlarged parathyroid gland(s) are presented.
  
  
  METHODS
  Nine patients were selected according to the Japanese Guideline for Selective PEIT. Using the same technique as PEIT, a dose of calcitriol that was approximately 200-300% of the calculated volume of the selected parathyroid gland was injected directly into the gland under ultrasonographic guidance.
  
  
  RESULTS
  In six cases, the intact PTH concentration decreased to <360 pg/ml. The total volume of the enlarged parathyroid gland(s) also decreased to 54.7% of the initial volume. The blood supply to the treated glands, as evaluated by colour Doppler imaging, appeared to diminish transiently after injection, probably from the volume effect of this procedure. The number of enlarged parathyroid glands was not a limiting factor for this therapy; however, a grossly enlarged parathyroid gland (>2000 mm(3)) appeared to be resistant to this intervention and an intrathoracic parathyroid gland was found in a non-responsive case. None of the patients had any severe complications, such as nerve palsy or massive haemorrhage.
  
  
  CONCLUSIONS
  This new approach to the control of 2HPT is recommended as an alternative pharmacological parathyroidectomy to surgical therapy.
authors.affiliation: Division of Nephrology and Dialysis Center, Kobe University Graduate School of Medicine, Japan.
authors.forename: Shohei
authors.initials: S
authors.lastname: Nakanishi
authors.forename: Shozo
authors.initials: S
authors.lastname: Yano
authors.forename: Rikako
authors.initials: R
authors.lastname: Nomura
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Tsukamoto
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Shimizu
authors.forename: Jeongsoo
authors.initials: J
authors.lastname: Shin
authors.forename: Masafumi
authors.initials: M
authors.lastname: Fukagawa
mesh_terms: D002117:Calcitriol / Q000008:administration & dosage*; D002120:Calcium Channel Agonists / Q000008:administration & dosage*; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D015552:Injections, Intralesional; D010280:Parathyroid Glands / Q000187:drug effects*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014511:Uremia / Q000150:complications*
chemical_list: D002120:Calcium Channel Agonists; D002117:Calcitriol