title: Safety and efficacy of percutaneous parathyroid ethanol ablation in patients with recurrent primary hyperparathyroidism and multiple endocrine neoplasia type 1.
abstract: BACKGROUND
  The most common feature of multiple endocrine neoplasia type 1 (MEN1) is primary hyperparathyroidism (PHP), which occurs in approximately 95% of MEN1 patients. Approximately 40-60% of patients with MEN1 develop recurrent hypercalcemia within 10-12 years after their initial parathyroid surgery and the successful management of recurrent PHP is challenging.
  
  
  OBJECTIVE
  This study sought to evaluate the safety and efficacy of percutaneous ethanol ablation (PEA) for the treatment of recurrent PHP in patients with MEN1. DESIGN, SETTING, PATIENTS, INTERVENTION, OUTCOME MEASURED: We performed an electronic search to identify patients with a billing code for MEN1 who were seen at Mayo Clinic between 1977 and 2013. Patients with recurrent PHP who underwent PEA were identified and their clinical information was collected. We performed t test analyses to compare mean values.
  
  
  RESULTS
  Thirty-seven patients underwent 80 PEA treatments that included 123 sessions of ethanol administration. Twenty-one patients were women (56.8%) and the mean age at diagnosis of PHP was 33.8 years. The mean preprocedure calcium level was 10.7 mg/dl ± 0.57 (SD) and the mean postprocedure calcium level was 9.6 mg/dl ± 0.76 (P < .01). In 14 treatments (18.9%) the postprocedure calcium was greater than 10.1 mg/dl. Postprocedure hypocalcemia occurred in six treatments (8.1%). Normocalcemia was achieved in 54 of the treatment episodes (73%) and the mean duration of normocalcemia was 24.8 months. PEA was safe with transient hoarseness occurring in four of the treatments (5%).
  
  
  CONCLUSIONS
  The treatment of recurrent PHP in patients with MEN1 represents a challenge that is associated with increased morbidity. PEA is an effective treatment option for achieving normocalcemia in the majority of the patients with MEN1. PEA is associated with low rates of hypocalcemia and no permanent complications.
authors.affiliation: Division of Endocrinology, Diabetes, Metabolism, and Nutrition, and Department of Internal Medicine (N.S.O., W.F.Y.), Division of Endocrine Surgery and Department of Surgery (G.B.T.), and Department of Radiology (R.A.L., C.C.R.), Mayo Clinic, Rochester Minnesota 55905.
authors.forename: Naykky
authors.initials: N
authors.lastname: Singh Ospina
authors.forename: Geoffrey B
authors.initials: GB
authors.lastname: Thompson
authors.forename: Robert A
authors.initials: RA
authors.lastname: Lee
authors.forename: Carl C
authors.initials: CC
authors.lastname: Reading
authors.forename: William F
authors.initials: WF
authors.lastname: Young
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects / Q000379:methods*; D000328:Adult; D002118:Calcium / Q000097:blood; D000431:Ethanol / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000150:complications / Q000601:surgery*; D008297:Male; D018761:Multiple Endocrine Neoplasia Type 1 / Q000097:blood / Q000150:complications / Q000601:surgery*; D010280:Parathyroid Glands / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000431:Ethanol; D002118:Calcium