Chemical Ablation of Recurrent and Persistent Secondary Hyperparathyroidism After Subtotal Parathyroidectomy
Despite preoperative localization or intraoperative parathyroid hormone, monitoring increased the operative successful rate, recurrent, and persistent secondary hyperparathyroidism are still unavoidable after parathyroidectomy or reoperation. We present our experience of using percutaneous ethanol i...
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| Veröffentlicht in: | Annals of surgery 2011-04, Vol.253 (4), p.786-790 |
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| creator | CHEN, Han-Hsiang LIN, Cheng-Jui WU, Chih-Jen LAI, Chuan-Tsai LIN, Jackson CHENG, Shin-Ping YANG, Tseng-Long |
| description | Despite preoperative localization or intraoperative parathyroid hormone, monitoring increased the operative successful rate, recurrent, and persistent secondary hyperparathyroidism are still unavoidable after parathyroidectomy or reoperation. We present our experience of using percutaneous ethanol injection therapy (PEIT) in treating these patients.
To conduct a prospective study of 49 patients with recurrent and persistent hyperparathyroidism using PEIT after subtotal parathyroidectomy or reoperative failure.
From January 2001 to August 2009, 49 patients with recurrent or persistent 2HPT after subtotal parathyroidectomy received PEIT. All dialysis patients were divided into 2 groups: recurrent group (n = 28) and persistent group (n = 21). Before PEIT, every patient received sestamibi-(99m)Tc scintigraphy (MIBI scanning), neck ultrasonography (US), bone scanning (T-score and Z-score), and parathyroid function testing. We compared the responses to PEIT treatment in the recurrent and persistent groups with the following parameters: treatment success rate, improvement in bone density, concurrence in diagnosis between US and MIBI scanning and complications.
Treatment success was defined as intact PTH < 300 pg/mL; recurrent group is 25 of 28 (89.3%) and persistent group is 20 of 21 (95.2%) (P = 0.694). There was no difference in success rate statistically. T-score in recurrent group before PEIT was -1.2 ± 0.9 and after treatment was -0.6 ± 0.6 (P = 0.004), which is statistically significant. In the persistent group, T-score before PEIT was -1.2 ± 1.0 and after treatment was -0.8 ± 0.6 (P = 0.101). There was no significant difference. For consistence between neck US and MIBI scanning were concordant in the recurrent group in 20 of 28 (71.4%); in persistent group, it was 14 of 21 (66.6%) (P = 0.245); there was no significant difference. Regarding the complications, only hypocalcemia was significantly more common in the recurrent group. Hypocalcemia occurred in 14 of 28 patients in the recurrent group and 6 of 21 in the persistent group (P = 0.022).
Regardless of which group patient was in, PEIT can achieve satisfying result when parathyroid masses were detected by US. Subtotal parathyroidectomy plus PEIT was probably the best combination for treatment of secondary hyperparathyroidism. |
| doi_str_mv | 10.1097/sla.0b013e318211ccc2 |
| format | Article |
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To conduct a prospective study of 49 patients with recurrent and persistent hyperparathyroidism using PEIT after subtotal parathyroidectomy or reoperative failure.
From January 2001 to August 2009, 49 patients with recurrent or persistent 2HPT after subtotal parathyroidectomy received PEIT. All dialysis patients were divided into 2 groups: recurrent group (n = 28) and persistent group (n = 21). Before PEIT, every patient received sestamibi-(99m)Tc scintigraphy (MIBI scanning), neck ultrasonography (US), bone scanning (T-score and Z-score), and parathyroid function testing. We compared the responses to PEIT treatment in the recurrent and persistent groups with the following parameters: treatment success rate, improvement in bone density, concurrence in diagnosis between US and MIBI scanning and complications.
Treatment success was defined as intact PTH < 300 pg/mL; recurrent group is 25 of 28 (89.3%) and persistent group is 20 of 21 (95.2%) (P = 0.694). There was no difference in success rate statistically. T-score in recurrent group before PEIT was -1.2 ± 0.9 and after treatment was -0.6 ± 0.6 (P = 0.004), which is statistically significant. In the persistent group, T-score before PEIT was -1.2 ± 1.0 and after treatment was -0.8 ± 0.6 (P = 0.101). There was no significant difference. For consistence between neck US and MIBI scanning were concordant in the recurrent group in 20 of 28 (71.4%); in persistent group, it was 14 of 21 (66.6%) (P = 0.245); there was no significant difference. Regarding the complications, only hypocalcemia was significantly more common in the recurrent group. Hypocalcemia occurred in 14 of 28 patients in the recurrent group and 6 of 21 in the persistent group (P = 0.022).
Regardless of which group patient was in, PEIT can achieve satisfying result when parathyroid masses were detected by US. Subtotal parathyroidectomy plus PEIT was probably the best combination for treatment of secondary hyperparathyroidism.</description><identifier>ISSN: 0003-4932</identifier><identifier>EISSN: 1528-1140</identifier><identifier>DOI: 10.1097/sla.0b013e318211ccc2</identifier><identifier>PMID: 21475021</identifier><identifier>CODEN: ANSUA5</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Ablation Techniques - methods ; Administration, Cutaneous ; Aged ; Biological and medical sciences ; Chi-Square Distribution ; Chronic Disease ; Cohort Studies ; Endocrinopathies ; Ethanol - therapeutic use ; Female ; Follow-Up Studies ; General aspects ; Humans ; Hyperparathyroidism, Secondary - drug therapy ; Hyperparathyroidism, Secondary - etiology ; Hyperparathyroidism, Secondary - surgery ; Male ; Medical sciences ; Middle Aged ; Non tumoral diseases. Target tissue resistance. Benign neoplasms ; Parathyroid Glands - drug effects ; Parathyroidectomy - methods ; Parathyroids. Parafollicular cells. Cholecalciferol. Phosphocalcic homeostasis (diseases) ; Postoperative Complications - diagnosis ; Postoperative Complications - drug therapy ; Recurrence ; Renal Dialysis - adverse effects ; Renal Dialysis - methods ; Retrospective Studies ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of endocrine glands ; Treatment Outcome</subject><ispartof>Annals of surgery, 2011-04, Vol.253 (4), p.786-790</ispartof><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c402t-24f700db4d1d2f60395c18b74b4c82b785428ff4714bbf33a4adb64eb4eaba463</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24024674$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21475021$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>CHEN, Han-Hsiang</creatorcontrib><creatorcontrib>LIN, Cheng-Jui</creatorcontrib><creatorcontrib>WU, Chih-Jen</creatorcontrib><creatorcontrib>LAI, Chuan-Tsai</creatorcontrib><creatorcontrib>LIN, Jackson</creatorcontrib><creatorcontrib>CHENG, Shin-Ping</creatorcontrib><creatorcontrib>YANG, Tseng-Long</creatorcontrib><title>Chemical Ablation of Recurrent and Persistent Secondary Hyperparathyroidism After Subtotal Parathyroidectomy</title><title>Annals of surgery</title><addtitle>Ann Surg</addtitle><description>Despite preoperative localization or intraoperative parathyroid hormone, monitoring increased the operative successful rate, recurrent, and persistent secondary hyperparathyroidism are still unavoidable after parathyroidectomy or reoperation. We present our experience of using percutaneous ethanol injection therapy (PEIT) in treating these patients.
To conduct a prospective study of 49 patients with recurrent and persistent hyperparathyroidism using PEIT after subtotal parathyroidectomy or reoperative failure.
From January 2001 to August 2009, 49 patients with recurrent or persistent 2HPT after subtotal parathyroidectomy received PEIT. All dialysis patients were divided into 2 groups: recurrent group (n = 28) and persistent group (n = 21). Before PEIT, every patient received sestamibi-(99m)Tc scintigraphy (MIBI scanning), neck ultrasonography (US), bone scanning (T-score and Z-score), and parathyroid function testing. We compared the responses to PEIT treatment in the recurrent and persistent groups with the following parameters: treatment success rate, improvement in bone density, concurrence in diagnosis between US and MIBI scanning and complications.
Treatment success was defined as intact PTH < 300 pg/mL; recurrent group is 25 of 28 (89.3%) and persistent group is 20 of 21 (95.2%) (P = 0.694). There was no difference in success rate statistically. T-score in recurrent group before PEIT was -1.2 ± 0.9 and after treatment was -0.6 ± 0.6 (P = 0.004), which is statistically significant. In the persistent group, T-score before PEIT was -1.2 ± 1.0 and after treatment was -0.8 ± 0.6 (P = 0.101). There was no significant difference. For consistence between neck US and MIBI scanning were concordant in the recurrent group in 20 of 28 (71.4%); in persistent group, it was 14 of 21 (66.6%) (P = 0.245); there was no significant difference. Regarding the complications, only hypocalcemia was significantly more common in the recurrent group. Hypocalcemia occurred in 14 of 28 patients in the recurrent group and 6 of 21 in the persistent group (P = 0.022).
Regardless of which group patient was in, PEIT can achieve satisfying result when parathyroid masses were detected by US. Subtotal parathyroidectomy plus PEIT was probably the best combination for treatment of secondary hyperparathyroidism.</description><subject>Ablation Techniques - methods</subject><subject>Administration, Cutaneous</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Chi-Square Distribution</subject><subject>Chronic Disease</subject><subject>Cohort Studies</subject><subject>Endocrinopathies</subject><subject>Ethanol - therapeutic use</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>General aspects</subject><subject>Humans</subject><subject>Hyperparathyroidism, Secondary - drug therapy</subject><subject>Hyperparathyroidism, Secondary - etiology</subject><subject>Hyperparathyroidism, Secondary - surgery</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Non tumoral diseases. Target tissue resistance. Benign neoplasms</subject><subject>Parathyroid Glands - drug effects</subject><subject>Parathyroidectomy - methods</subject><subject>Parathyroids. Parafollicular cells. Cholecalciferol. Phosphocalcic homeostasis (diseases)</subject><subject>Postoperative Complications - diagnosis</subject><subject>Postoperative Complications - drug therapy</subject><subject>Recurrence</subject><subject>Renal Dialysis - adverse effects</subject><subject>Renal Dialysis - methods</subject><subject>Retrospective Studies</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of endocrine glands</subject><subject>Treatment Outcome</subject><issn>0003-4932</issn><issn>1528-1140</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkEFr3DAQhUVpaLZp_0EpvpSenM5Is5b2uCxtU1hoyCZnI8kj4mJbW0k-7L-vQ7YN9DQM8703vCfEB4RrhI3-kgd7DQ5QsUIjEb338pVY4VqaGpHgtVgBgKppo-SleJvzLwAkA_qNuJRIeg0SV2LYPfLYeztUWzfY0sepiqG6Yz-nxFOp7NRVt5xyn8vTemAfp86mU3VzOnI62mTL4ynFvuvzWG1D4VQdZldiWRxvX67sSxxP78RFsEPm9-d5JR6-fb3f3dT7n99_7Lb72hPIUksKGqBz1GEnQwNqs_ZonCZH3kinzZqkCYE0knNBKUu2cw2xI7bOUqOuxOdn32OKv2fOpR377HkY7MRxzq1pUIJW0iwkPZM-xZwTh_aY-nHJ1yK0TzW3h_22_b_mRfbx_GB2I3f_RH97XYBPZ8DmpdyQ7OT7_MItOanRpP4AwoCJig</recordid><startdate>20110401</startdate><enddate>20110401</enddate><creator>CHEN, Han-Hsiang</creator><creator>LIN, Cheng-Jui</creator><creator>WU, Chih-Jen</creator><creator>LAI, Chuan-Tsai</creator><creator>LIN, Jackson</creator><creator>CHENG, Shin-Ping</creator><creator>YANG, Tseng-Long</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20110401</creationdate><title>Chemical Ablation of Recurrent and Persistent Secondary Hyperparathyroidism After Subtotal Parathyroidectomy</title><author>CHEN, Han-Hsiang ; LIN, Cheng-Jui ; WU, Chih-Jen ; LAI, Chuan-Tsai ; LIN, Jackson ; CHENG, Shin-Ping ; YANG, Tseng-Long</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c402t-24f700db4d1d2f60395c18b74b4c82b785428ff4714bbf33a4adb64eb4eaba463</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Ablation Techniques - methods</topic><topic>Administration, Cutaneous</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Chi-Square Distribution</topic><topic>Chronic Disease</topic><topic>Cohort Studies</topic><topic>Endocrinopathies</topic><topic>Ethanol - therapeutic use</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>General aspects</topic><topic>Humans</topic><topic>Hyperparathyroidism, Secondary - drug therapy</topic><topic>Hyperparathyroidism, Secondary - etiology</topic><topic>Hyperparathyroidism, Secondary - surgery</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Non tumoral diseases. Target tissue resistance. Benign neoplasms</topic><topic>Parathyroid Glands - drug effects</topic><topic>Parathyroidectomy - methods</topic><topic>Parathyroids. Parafollicular cells. Cholecalciferol. Phosphocalcic homeostasis (diseases)</topic><topic>Postoperative Complications - diagnosis</topic><topic>Postoperative Complications - drug therapy</topic><topic>Recurrence</topic><topic>Renal Dialysis - adverse effects</topic><topic>Renal Dialysis - methods</topic><topic>Retrospective Studies</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of endocrine glands</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>CHEN, Han-Hsiang</creatorcontrib><creatorcontrib>LIN, Cheng-Jui</creatorcontrib><creatorcontrib>WU, Chih-Jen</creatorcontrib><creatorcontrib>LAI, Chuan-Tsai</creatorcontrib><creatorcontrib>LIN, Jackson</creatorcontrib><creatorcontrib>CHENG, Shin-Ping</creatorcontrib><creatorcontrib>YANG, Tseng-Long</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>CHEN, Han-Hsiang</au><au>LIN, Cheng-Jui</au><au>WU, Chih-Jen</au><au>LAI, Chuan-Tsai</au><au>LIN, Jackson</au><au>CHENG, Shin-Ping</au><au>YANG, Tseng-Long</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Chemical Ablation of Recurrent and Persistent Secondary Hyperparathyroidism After Subtotal Parathyroidectomy</atitle><jtitle>Annals of surgery</jtitle><addtitle>Ann Surg</addtitle><date>2011-04-01</date><risdate>2011</risdate><volume>253</volume><issue>4</issue><spage>786</spage><epage>790</epage><pages>786-790</pages><issn>0003-4932</issn><eissn>1528-1140</eissn><coden>ANSUA5</coden><abstract>Despite preoperative localization or intraoperative parathyroid hormone, monitoring increased the operative successful rate, recurrent, and persistent secondary hyperparathyroidism are still unavoidable after parathyroidectomy or reoperation. We present our experience of using percutaneous ethanol injection therapy (PEIT) in treating these patients.
To conduct a prospective study of 49 patients with recurrent and persistent hyperparathyroidism using PEIT after subtotal parathyroidectomy or reoperative failure.
From January 2001 to August 2009, 49 patients with recurrent or persistent 2HPT after subtotal parathyroidectomy received PEIT. All dialysis patients were divided into 2 groups: recurrent group (n = 28) and persistent group (n = 21). Before PEIT, every patient received sestamibi-(99m)Tc scintigraphy (MIBI scanning), neck ultrasonography (US), bone scanning (T-score and Z-score), and parathyroid function testing. We compared the responses to PEIT treatment in the recurrent and persistent groups with the following parameters: treatment success rate, improvement in bone density, concurrence in diagnosis between US and MIBI scanning and complications.
Treatment success was defined as intact PTH < 300 pg/mL; recurrent group is 25 of 28 (89.3%) and persistent group is 20 of 21 (95.2%) (P = 0.694). There was no difference in success rate statistically. T-score in recurrent group before PEIT was -1.2 ± 0.9 and after treatment was -0.6 ± 0.6 (P = 0.004), which is statistically significant. In the persistent group, T-score before PEIT was -1.2 ± 1.0 and after treatment was -0.8 ± 0.6 (P = 0.101). There was no significant difference. For consistence between neck US and MIBI scanning were concordant in the recurrent group in 20 of 28 (71.4%); in persistent group, it was 14 of 21 (66.6%) (P = 0.245); there was no significant difference. Regarding the complications, only hypocalcemia was significantly more common in the recurrent group. Hypocalcemia occurred in 14 of 28 patients in the recurrent group and 6 of 21 in the persistent group (P = 0.022).
Regardless of which group patient was in, PEIT can achieve satisfying result when parathyroid masses were detected by US. Subtotal parathyroidectomy plus PEIT was probably the best combination for treatment of secondary hyperparathyroidism.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>21475021</pmid><doi>10.1097/sla.0b013e318211ccc2</doi><tpages>5</tpages></addata></record> |
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| ispartof | Annals of surgery, 2011-04, Vol.253 (4), p.786-790 |
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| subjects | Ablation Techniques - methods Administration, Cutaneous Aged Biological and medical sciences Chi-Square Distribution Chronic Disease Cohort Studies Endocrinopathies Ethanol - therapeutic use Female Follow-Up Studies General aspects Humans Hyperparathyroidism, Secondary - drug therapy Hyperparathyroidism, Secondary - etiology Hyperparathyroidism, Secondary - surgery Male Medical sciences Middle Aged Non tumoral diseases. Target tissue resistance. Benign neoplasms Parathyroid Glands - drug effects Parathyroidectomy - methods Parathyroids. Parafollicular cells. Cholecalciferol. Phosphocalcic homeostasis (diseases) Postoperative Complications - diagnosis Postoperative Complications - drug therapy Recurrence Renal Dialysis - adverse effects Renal Dialysis - methods Retrospective Studies Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of endocrine glands Treatment Outcome |
| title | Chemical Ablation of Recurrent and Persistent Secondary Hyperparathyroidism After Subtotal Parathyroidectomy |
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