Ultrasound-guided laser thermal ablation for parathyroid adenomas: analysis of three cases with a three-year follow-up.
BACKGROUND
In patients with primary hyperparathyroidism (pHPT) the therapeutical choice is surgery. In patients with high surgical and anesthetic risks, ultrasound-guided laser ablation (LTA) of parathyroid adenoma has been reported to reduce parathyroid hormone (PTH) hypersecretion without relevant side effects. No data are available from patients followed for >6 months. We report our 3-year follow-up experience with LTA in 3 patients affected by pHPT due to a parathyroid tumor.


METHODS
LTA was performed under color-Doppler ultrasound guidance with a continuous pulse at 2 W (total treatment duration: 300 s in each session; total energy: 1,200 J in two sessions).


RESULTS
In the first patient who refused to undergo the second LTA session, calcium, PTH levels and parathyroid lesion volume showed a slight reduction, returning to baseline values in a month. In the second patient, no modification of parathyroid lesion was obtained even if calcium levels temporarily normalized. In the third patient, LTA led to normalization of calcium and PTH levels and to a 99% reduction of parathyroid volume.


CONCLUSIONS
After LTA procedures the long-term disease remission of pHPT is achievable in a minority of patients. Data from larger samples are needed to verify the usefulness of this procedure.
Unit of Endocrinology, San Giuseppe-Fatebenefratelli Hospital, AFaR, Milan, Italy.guidoadda@tiscali.it
G
G
Adda
A
A
Scillitani
P
P
Epaminonda
S
S
Di Lembo
F
F
Motta
P
P
Cecconi
G
G
Vecchi
M
M
Arosio
I
I
Chiodini
D000236:Adenoma / Q000097:blood / Q000000981:diagnostic imaging / Q000601:surgery*; D000368:Aged; D002118:Calcium / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000000981:diagnostic imaging / Q000601:surgery; D017075:Laser Coagulation; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color
D010281:Parathyroid Hormone; D002118:Calcium