Percutaneous ethanol injection therapy in patients with primary and secondary hyperparathyroidism
Spyros Stratigis, Kostas Stylianou, Evangelia Mamalaki, Eleftheria vardaki, Nikolaos Tzenakis, Eirini Katsipi, Paraskevi Tzoutzouraki & Eugenios Dafnis
Introduction: Recent years PEIT has been introduced as an alternative to parathyroidectomy. We evaluated the results of PEIT in patients with primary (pHPT) or secondary hyperparathyroidism (sHPT).
Patients and methods: 18 patients (6M/12F) with pHPT and 20 patients (7M/13F) with sHPT underwent PEIT between 2001 and 2005 and had a mean follow up of 24.3±9 and 27±10 months respectively. The PTGs were identified and blood supply to the gland was examined by power Doppler ultrasonography pre and post infusion. 95% ethanol was injected at a volume 85% of the PTG volume. pHTP patients underwent a total of 51 ethanol infusions. sHPT patients underwent a total of 76 infusions in 30 adenomas The volume of the PTGs, serum iPTH, calcium, phosphate, albumin and alkaline phosphatase were measured at the beginning and after each infusion. The patients were divided to responders and non responders based on the normalization of iPTH levels at.
Results: In the pHPT group, 11 patients (61.1%) normalized iPTH levels, 5 (27.8%) had a significant (>50%) reduction of iPTH levels and 2 (11.1%) had a modest response (<50% reduction of PTH) and were referred for surgery. In all patients calcium levels decreased significantly (10.96±0.84 mg/dl to 9.81±0.6)(P<0.001). Phosphorus increased from 2.52±0.38 mg/dl to 2.96±0.5 mg/dl (P=0.05).
In the sHPT group PTH decreased significantly (1280.9±447 pg/ml to 770.5±465, P<0.001) in all patients; however it was normal in only 3 patients (15%). Phosphorus decreased from 5.57±0.47 mg/dl to 4.93±0.42 mg/dl (P=0.03).
Conclusions: PEIT is a safe and easy to perform technique for the treatment of HPT. In patients with pHPT may be a considerable alternative to surgical PTx with a curative rate of 61% in our series. In patients with sHPT appears a significant adjunct to medical therapy since it reduced iPTH levels by 42%.