Case Report
Nephron 1992;62:100-103
a Internal Medicine of Kurobe Municipal Hospital Kurobe, Toyama b Department of Nuclear Medicine School of Medicine Kanazawa University Kanazawa, Ishikawa, Japan
Key Words Secondary hyperparathyroidism Uremia Percutaneous ethanol injection
Successful Ultrasonically Guided Percutaneous Ethanol Injection for Secondary Hyperparathyroidism
Abstract Ultrasonically guided percutaneous ethanol injection to all of four enlarged parathyroid glands, which were confirmed by fine-needle aspiration biopsy, was successfully performed in a hemodialysis patient with secondary hyperparathy roidism. In addition to marked reduction of serum parathyroid hormone, the size of parathyroid glands was significantly decreased after the procedure. As an adverse effect, the patient experienced a transient self-limiting dysphonia due to right recurrent nerve palsy after the first injection. This procedure may be an effective alternative to surgical treatment or administration of high-dose l,25(OH)2 vitamin D? in uremic patients with sonographically verified multiple enlarged parathyroid glands.
Introduction Secondary hyperparathyroidism is one of the major complications in patients undergoing maintenance hemo dialysis. Recently therapeutic strategies, using high-dose l,25(OH)2 vitamin D3 either alone or in combination with phosphate binders, have resulted in adequate suppression of parathyroid hormone (PTH) [1-5]. However, these ther apies have often been associated with hypercalcemia and have failed to completely reverse the increased PTH release in patients with severe parathyroid hyperplasia. In 1985, Solbiati et al. [6] first reported on the successful percutaneous injection of ethanol into one enlarged para thyroid gland under ultrasound guidance in 7 uremic pa tients with secondary hyperparathyroidism, and later Charboneau et al. [7] employed the injection in a patient
Accepted : October 18.1991
with primary hyperparathyroidism. To our knowledge, no cases of successful ethanol ablation of multiple enlarged parathyroid glands have been reported. In this article, we describe a hemodialysis patient with four enlarged parathy roid glands, all of which were successfully ablated by ultra sonically guided percutaneous ethanol injection.
Case Report A 34-year-old female was entered into maintenance hemodialysis in April 1989, when she complained of muscle weakness. In pre-dialy sis laboratory tests, the serum calcium level was 4.2 m Eq/l (normal: 4.5- 5.5 m Eq/l) and serum phosphorus was 8.2 mg/dl (normal: 2.5- 4.3 mg/dl). Serum intact PTH examined with the Allegro intact PTH kit (Nichols Institute, San Juan Capistrano, Calif., USA) [8] and carboxy-terminal PTH (PTH-c)examined with the immuno PTH-c kit
Shin-ichi Takcda. MD Internal Medicine of Kurobe Municipal Hospital 1108-1 Mikkaichi, Kurobe Toyama. 938 (Japan)
© 1992 S. Kargcr AG. Basel 0028-2766/92/ 0621 0I00S2.75/0
Downloaded by: Kings's College London 137.73.144.138 - 11/19/2017 7:14:57 PM
Shin-ichi Takeclaa Takcitoshi Michigishib Eisuke Takazakuraa
Fig. 1. Radiographic findings of the middle phalanx of the right second digit before (a) and after (b) the ethanol injection.
Fig. 2. Computed tomographic findings of the right upper (RU), right lower (RL), left upper (LU) and left lower (LL) parathyroid glands before (left) and after (right) the percutaneous ethanol injection (PEI).
Fig. 3. A transducer with a lateral puncture adaptor for ultrasound guidance (a) and ultrasonographic findings of the right upper parathy roid gland (b). Caliper markers show the guideline through which the needle is inserted.
I0l
Downloaded by: Kings's College London 137.73.144.138 - 11/19/2017 7:14:57 PM
(IncstarCo.. Stillwater, Minn., USA) [9] had been markedly elevated to 1,305 pg/ml(normal: < 120p g/m l)an d 43.0ng/ml(normal:
Nephron 1992;62:100-103
a Internal Medicine of Kurobe Municipal Hospital Kurobe, Toyama b Department of Nuclear Medicine School of Medicine Kanazawa University Kanazawa, Ishikawa, Japan
Key Words Secondary hyperparathyroidism Uremia Percutaneous ethanol injection
Successful Ultrasonically Guided Percutaneous Ethanol Injection for Secondary Hyperparathyroidism
Abstract Ultrasonically guided percutaneous ethanol injection to all of four enlarged parathyroid glands, which were confirmed by fine-needle aspiration biopsy, was successfully performed in a hemodialysis patient with secondary hyperparathy roidism. In addition to marked reduction of serum parathyroid hormone, the size of parathyroid glands was significantly decreased after the procedure. As an adverse effect, the patient experienced a transient self-limiting dysphonia due to right recurrent nerve palsy after the first injection. This procedure may be an effective alternative to surgical treatment or administration of high-dose l,25(OH)2 vitamin D? in uremic patients with sonographically verified multiple enlarged parathyroid glands.
Introduction Secondary hyperparathyroidism is one of the major complications in patients undergoing maintenance hemo dialysis. Recently therapeutic strategies, using high-dose l,25(OH)2 vitamin D3 either alone or in combination with phosphate binders, have resulted in adequate suppression of parathyroid hormone (PTH) [1-5]. However, these ther apies have often been associated with hypercalcemia and have failed to completely reverse the increased PTH release in patients with severe parathyroid hyperplasia. In 1985, Solbiati et al. [6] first reported on the successful percutaneous injection of ethanol into one enlarged para thyroid gland under ultrasound guidance in 7 uremic pa tients with secondary hyperparathyroidism, and later Charboneau et al. [7] employed the injection in a patient
Accepted : October 18.1991
with primary hyperparathyroidism. To our knowledge, no cases of successful ethanol ablation of multiple enlarged parathyroid glands have been reported. In this article, we describe a hemodialysis patient with four enlarged parathy roid glands, all of which were successfully ablated by ultra sonically guided percutaneous ethanol injection.
Case Report A 34-year-old female was entered into maintenance hemodialysis in April 1989, when she complained of muscle weakness. In pre-dialy sis laboratory tests, the serum calcium level was 4.2 m Eq/l (normal: 4.5- 5.5 m Eq/l) and serum phosphorus was 8.2 mg/dl (normal: 2.5- 4.3 mg/dl). Serum intact PTH examined with the Allegro intact PTH kit (Nichols Institute, San Juan Capistrano, Calif., USA) [8] and carboxy-terminal PTH (PTH-c)examined with the immuno PTH-c kit
Shin-ichi Takcda. MD Internal Medicine of Kurobe Municipal Hospital 1108-1 Mikkaichi, Kurobe Toyama. 938 (Japan)
© 1992 S. Kargcr AG. Basel 0028-2766/92/ 0621 0I00S2.75/0
Downloaded by: Kings's College London 137.73.144.138 - 11/19/2017 7:14:57 PM
Shin-ichi Takeclaa Takcitoshi Michigishib Eisuke Takazakuraa
Fig. 1. Radiographic findings of the middle phalanx of the right second digit before (a) and after (b) the ethanol injection.
Fig. 2. Computed tomographic findings of the right upper (RU), right lower (RL), left upper (LU) and left lower (LL) parathyroid glands before (left) and after (right) the percutaneous ethanol injection (PEI).
Fig. 3. A transducer with a lateral puncture adaptor for ultrasound guidance (a) and ultrasonographic findings of the right upper parathy roid gland (b). Caliper markers show the guideline through which the needle is inserted.
I0l
Downloaded by: Kings's College London 137.73.144.138 - 11/19/2017 7:14:57 PM
(IncstarCo.. Stillwater, Minn., USA) [9] had been markedly elevated to 1,305 pg/ml(normal: < 120p g/m l)an d 43.0ng/ml(normal:
