Percutaneous ethanol injection therapy: a surgery-sparing treatment for primary hyperparathyroidism.
OBJECTIVE
To describe our 3-year experience in the long-term efficacy and safety of percutaneous ethanol injection therapy (PEIT), as an alternative to surgery for the management of patients with primary hyperparathyroidism (p-HPT).


METHODS
Prospective study with a mean follow-up of 19.6 +/- 10.6 months.


METHODS
Our study population included 19 consecutive high risk patients with p-HPT, who met the criteria for surgery.


METHODS
Under ultrasonic guidance, ethanol (95%) was injected into parathyroid glands with a volume of >or= 0.15 cm(3). With the aim of normalizing intact parathormone (iPTH) values, repeated ethanol injections were carried out, in an interval of 2 weeks, until normalization of iPTH was reached or until no residual blood supply was detected by ultrasound in the gland. Biochemical parameters were monitored throughout the study.


RESULTS
At 6-month follow-up, normalization of iPTH levels (10-65 ng/l) was achieved in 11 (58%) patients (responders). Of the eight remaining patients (nonresponders), six patients had reduced (but not normalized) iPTH levels and two patients required parathyroid surgery. Seventeen (11 responders and 6 nonresponders) of the 19 patients (89.5%) became normocalcaemic (serum Ca <or= 2.57 mmol/l) and remained so for a mean follow-up of 21 months (8-39 months). The odds ratio (P < 0.05) of response vs. no response to PEIT was 16.7-fold for pretreatment iPTH < 200 vs. > 200 ng/l. The only complication was a transient dysphonia noticed in three patients.


CONCLUSIONS
PEIT is a safe and effective nonsurgical treatment for patients with p-HPT, who are unsuitable for surgical intervention.
Stratigis
Spyros
S
Departments of Nephrology, University Hospital of Heraklion, Crete, Greece.
Stylianou
Kostas
K
Mamalaki
Evangelia
E
Perakis
Kostas
K
Vardaki
Eleftheria
E
Tzenakis
Nikolaos
N
Katsipi
Irene
I
Papavasiliou
Stathis
S
Yarmenitis
Spyros
S
Kyriazis
John
J
Daphnis
Eugene
E
D000236:Adenoma / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D000279:Administration, Cutaneous; D000368:Aged; D000529:Complementary Therapies / Q000379:methods*; D000075202:Contraindications; D000431:Ethanol / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D016105:Parathyroidectomy; D011379:Prognosis; D016896:Treatment Outcome; D014463:Ultrasonography
D010281:Parathyroid Hormone; D000431:Ethanol