Indications, technique, and efficacy of alcohol injection of enlarged parathyroid glands in patients with primary hyperparathyroidism

Background: Percutaneous alcohol ablation of the parathyroid gland (PAAP) has been proposed as an alternative treatment for primary hyperparathyroidism in patients unsuitable for surgery. The current study aimed to determine the (1) selection criteria, (2) associated morbidity, and (3) efficacy of P...

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Published in:Surgery 1998-12, Vol.124 (6), p.1011-1020
Main Authors: Harman, C.Richard, Grant, Clive S., Hay, Ian D., Hurley, Daniel L., van Heerden, Jon A., Thompson, Geoffrey B., Reading, Carl C., Charboneau, J.William
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Ethanol - administration & dosage
Female
Follow-Up Studies
Humans
Hyperparathyroidism - therapy
Male
Middle Aged
Treatment Failure
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Summary:Background: Percutaneous alcohol ablation of the parathyroid gland (PAAP) has been proposed as an alternative treatment for primary hyperparathyroidism in patients unsuitable for surgery. The current study aimed to determine the (1) selection criteria, (2) associated morbidity, and (3) efficacy of PAAP. Methods: From 1987 to 1998, 36 patients with primary hyperparathyroidism (mean age 65 years) underwent PAAP. The indications for PAAP were (1) medical comorbidity, (2) technically unsafe reoperative surgery, (3) partial ablation of a single remaining gland, and (4) patient choice. Results: There were no long-term complications. Two patients had temporary recurrent laryngeal nerve injury and 4 had temporary hypocalcemia. Over a median follow-up of 16 months, 12 (33%) of the patients remained eucalcemic. For analysis purposes patients were separated into 2 separate groups: 29 with attempted complete ablation and 7 with partial ablation of a single remaining gland only. Ten of the complete ablation group (34%) remained eucalcemic. In the partial ablation group only 2 remained eucalcemic, but all had adequately controlled serum calcium levels. Conclusion: PAAP should be considered for hyperparathyroid patients with excessive reoperative morbidity or prohibitive medical comorbidity or those in whom the intent is to partially ablate a single remaining enlarged gland. In these patients close follow-up of serum calcium is required, and repeat treatments may be necessary because recurrence of hypercalcemia is likely. (Surgery 1998;124:1011-20.)
ISSN:0039-6060
1532-7361
DOI:10.1067/msy.1998.91826