title: Chemical ablation of recurrent and persistent secondary hyperparathyroidism after subtotal parathyroidectomy.
abstract: BACKGROUND
  Despite preoperative localization or intraoperative parathyroid hormone, monitoring increased the operative successful rate, recurrent, and persistent secondary hyperparathyroidism are still unavoidable after parathyroidectomy or reoperation. We present our experience of using percutaneous ethanol injection therapy (PEIT) in treating these patients.
  
  
  OBJECTIVE
  To conduct a prospective study of 49 patients with recurrent and persistent hyperparathyroidism using PEIT after subtotal parathyroidectomy or reoperative failure.
  
  
  METHODS
  From January 2001 to August 2009, 49 patients with recurrent or persistent 2HPT after subtotal parathyroidectomy received PEIT. All dialysis patients were divided into 2 groups: recurrent group (n = 28) and persistent group (n = 21). Before PEIT, every patient received sestamibi-(99m)Tc scintigraphy (MIBI scanning), neck ultrasonography (US), bone scanning (T-score and Z-score), and parathyroid function testing. We compared the responses to PEIT treatment in the recurrent and persistent groups with the following parameters: treatment success rate, improvement in bone density, concurrence in diagnosis between US and MIBI scanning and complications.
  
  
  RESULTS
  Treatment success was defined as intact PTH < 300 pg/mL; recurrent group is 25 of 28 (89.3%) and persistent group is 20 of 21 (95.2%) (P = 0.694). There was no difference in success rate statistically. T-score in recurrent group before PEIT was -1.2 ± 0.9 and after treatment was -0.6 ± 0.6 (P = 0.004), which is statistically significant. In the persistent group, T-score before PEIT was -1.2 ± 1.0 and after treatment was -0.8 ± 0.6 (P = 0.101). There was no significant difference. For consistence between neck US and MIBI scanning were concordant in the recurrent group in 20 of 28 (71.4%); in persistent group, it was 14 of 21 (66.6%) (P = 0.245); there was no significant difference. Regarding the complications, only hypocalcemia was significantly more common in the recurrent group. Hypocalcemia occurred in 14 of 28 patients in the recurrent group and 6 of 21 in the persistent group (P = 0.022).
  
  
  CONCLUSIONS
  Regardless of which group patient was in, PEIT can achieve satisfying result when parathyroid masses were detected by US. Subtotal parathyroidectomy plus PEIT was probably the best combination for treatment of secondary hyperparathyroidism.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan. lincj@ms1.mmh.org.tw
authors.forename: Han-Hsiang
authors.initials: HH
authors.lastname: Chen
authors.forename: Cheng-Jui
authors.initials: CJ
authors.lastname: Lin
authors.forename: Chih-Jen
authors.initials: CJ
authors.lastname: Wu
authors.forename: Chuan-Tsai
authors.initials: CT
authors.lastname: Lai
authors.forename: Jackson
authors.initials: J
authors.lastname: Lin
authors.forename: Shin-Ping
authors.initials: SP
authors.lastname: Cheng
authors.forename: Tseng-Long
authors.initials: TL
authors.lastname: Yang
mesh_terms: D055011:Ablation Techniques / Q000379:methods*; D000279:Administration, Cutaneous; D000368:Aged; D016009:Chi-Square Distribution; D002908:Chronic Disease; D015331:Cohort Studies; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000187:drug effects*; D016105:Parathyroidectomy / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy; D012008:Recurrence; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000431:Ethanol