Percutaneous ethanol and calcitriol injection therapy for hyperparathyroidism – a single-centre experience

TL;DR

This study explores percutaneous ethanol and calcitriol injections as less invasive alternatives to surgery for treating hyperparathyroidism.

Contribution

The study evaluates the feasibility and safety of percutaneous ethanol and calcitriol injection therapies as outpatient alternatives to surgical treatment for hyperparathyroidism.

Findings

Two out of four patients treated with percutaneous ethanol injection therapy had successful outcomes.

Three out of five patients treated with percutaneous calcitriol therapy had successful outcomes.

The therapies are proposed as feasible and safe alternatives to surgery, though further research is needed.

Abstract

The purpose of this study is to evaluate the use of percutaneous ethanol and calcitriol injection therapy for hyperparathyroidism (HPT), while taking into account the efficacy, safety and feasibility as an ambulatory procedure alternative to surgical parathyroidectomy.

We included nine patients who underwent percutaneous injection therapy for HPT from January 2018 to December 2021 in our institution. They were followed up from date of first percutaneous injection until death or October 2022 (mean duration of 9.0 months).

Four patients underwent percutaneous ethanol injection therapy (PEIT) (mean age 61.0 [31–89] years old), while the remaining five underwent percutaneous calcitriol therapy (PCIT) (mean age 62.6 [35–91] years old). The analyzed parameters are age, BMI, serum turn over markers as iPTH, Ca, alkaline phosphatase and vitamin D. Two out of the four patients undergoing PEIT had a successful outcome, although one needed to continue cinacalcet due to persistent serum calcium levels. Three out of five PCIT patients in our series had successful procedure, although one subsequently developed refractory disease.

PEIT and PCIT are feasible and safe therapeutic alternatives to surgical parathyroidectomy in HPT refractory to medical treatment, with postulated benefits of decreased costs and being an outpatient procedure. However, further studies are necessary to evaluate the efficacy and cost-effectiveness with these techniques prior to widespread adoption.

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