Endocrine Abstracts

JOINT1865

Primary Hyperparathyroidism (PHPT) is an endocrine disorder characterized by excessive production of parathyroid hormone (PTH), typically due to parathyroid adenomas, leading to hypercalcemia and its associated symptoms. Although surgery is a first-line treatment for PHPT, radiofrequency ablation (RFA) emerged as a minimally invasive alternative, especially for patients with comorbidities or those who want to avoid surgery. This poster presents a case study and a literature review of RFA in PHPT. A 78-year-old female patient with a history of breast cancer on aromatase inhibitors, type 2 diabetes mellitus, heart failure, atrial fibrillation with a pacemaker and atrophic gastritis was admitted to emergency department of our hospital with symptoms of hypercalcemia including weakness, anorexia, and nausea. Laboratory tests showed elevated serum calcium [corrected Ca²⁺: 12.5 mg/dl (normal range: 8.4-10.5)] and PTH levels [PTH: 171.4 pg/ml (normal range: 55-65)] while imaging tests revealed a 23.5 mm parathyroid adenoma. After excluding other causes of hypercalcemia, the patient was diagnosed with PHPT. Considering the patient’s comorbidities and her refusal to undergo surgery, RFA was chosen as a treatment option which was performed under ultrasound guidance and local anesthesia. The procedure involved hydro-dissection to protect surrounding structures. During the post-ablation period, patients improved clinically; subsequent follow-up confirmed a steady decline in calcium and PTH levels over 12 months and a 90% reduction in adenoma volume. A literature review was conducted for the efficacy of RFA in treatment of PHPT, based on recent studies. The RFA outcomes were promising as substantial reductions in PTH and calcium levels were noted, along with symptoms’ relief and parathyroid adenoma volume rate reduction (VRR). Studies showed that the overall success rate was approximately 92%. Studies which compared RFA with parathyroidectomy found that surgery was more effective in lowering PTH levels since there is the risk of incomplete ablation in larger lesions and potential recurrence. However, RFA had lower rates of severe hypocalcemia, compared to patients undergoing parathyroidectomy, who experience a rapid drop in PTH levels and a rapid calcium influx into “the hungry bones” all resulting in decreased serum calcium levels. Other benefits of RFA are lower complication rate, faster recovery and lack of visible scarring making it an alternative option for patients with multiple comorbidities. In conclusion, RFA presents an effective alternative to parathyroidectomy for the treatment of PHPT. However, ongoing research is needed to optimize its role in clinical practice.