title: Long-term effectiveness of ultrasound-guided laser ablation of hyperfunctioning parathyroid adenomas: present and future perspectives.
abstract: OBJECTIVE
  Although surgery is the first-choice treatment of primary hyperparathyroidism (pHPT), some patients present with contraindications or refuse surgery. Data from alternative nonsurgical therapies are inconclusive. To study the long-term efficacy of laser ablation in the treatment of pHPT, we retrospectively reviewed six cases of laser-treated patients.
  
  
  METHODS
  Six patients with pHPT were treated with laser ablation using a flat-tip technique. Energy was administered by means of one optic fiber placed into the parathyroid adenoma through a 21-gauge Chiba needle connected to a neodymium:yttrium-aluminum-garnet laser. The mean (± SD) delivered energy for all patients was 2.067 ± 1440 J (range, 1000-4200 J). Treatment was fractionated in two (n = 2 patients) or in three (n = 1 patient) ultrasound-guided sessions. Patients' serum parathyroid hormone (PTH) and calcium levels were checked periodically, with neck ultrasound performed. The mean duration of follow-up was 54 ± 34 months (range, 12-84 months).
  
  
  RESULTS
  Two months after laser ablation, serum PTH and calcium levels decreased in six and five patients, respectively. At the last follow-up examination, serum PTH and calcium levels were above the normal range in six and three patients, respectively. Three patients underwent surgery for persistent pHPT. Laser ablation therapy was safe and without permanent side effects. One patient reported transient dysphonia.
  
  
  CONCLUSIONS
  Laser ablation produces a transient reduction of serum PTH and calcium levels but not a lasting resolution of hyperparathyroidism. Laser cannot be proposed as the definitive therapy of pHPT. Thus, studies aiming to identify therapeutic algorithms specific for parathyroid glands are needed to verify the utility of laser ablation in pHPT.
authors.affiliation: Endocrinology Unit, Department of Surgery, Azienda Ospedaliera Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Viale Risorgimento 80, Reggio Emilia 42100, Italy. massimoandrioli1@virgilio.it
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Andrioli
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Riganti
authors.forename: Claudio Maurizio
authors.initials: CM
authors.lastname: Pacella
authors.forename: Roberto
authors.initials: R
authors.lastname: Valcavi
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging / Q000601:surgery*; D000368:Aged; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D053844:Lasers, Solid-State; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional