Treatment of refractory secondary hyperparathyroidism with ethanol injection: The importance of glandular volume

Background. Percutaneous ethanol injection treatment (PEIT) has been proposed as an alternative to surgery for patients with secondary hyperparathyroidism. The present study was undertaken to determine factors that may predict results. Methods. We performed PEIT in 19 patients with secondary hyperparathyroidism refractory to medical therapy under ultrasonographic guidance in an ambulatory facility with local anesthesia. Biochemical assays were performed immediately before the last dialysis session (basal) and between I to 7 days after PEIT (post-PEIT). Results. Serum PTH, calcium, and phosphorus levels decreased significantly after treatment. The percent of change in serum PTH was significantly correlated to total nodular volume (r = 0.73, P = 0.0004), and basal PTH levels (r = 0.48, P = 0.03). Post-PEIT serum phosphate and calcium x phosphate product disclosed negative correlations that were statistically significant with the decrease of PTH levels (r = -0.60, P = 0.009, and r = -0.60, P = 0.01, respectively). The total nodular volume was significantly correlated to the percent change in serum calcium levels (r = 0.60, P = 0.01), in phosphate levels (r = 0.64, P = 0.009), and calcium x phosphate product (r 0.66, P = 0.01). Conclusion. Our findings suggest that patients with uncontrolled secondary hyperparathyroidism may benefit from PEIT if they present with very high basal PTH levels and/or big nodule size.