Nonsurgical treatment of primary hyperparathyroidism with sonographically guided percutaneous injection of ethanol: results in a selected series of patients.

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Abstract
Twelve patients with primary hyperparathyroidism were treated with sonographically guided percutaneous injection of ethanol (96%) into solitary parathyroid tumors verified by biopsy. The patients were all selected for nonoperative chemical parathyroid ablation either because of acute severe hypercalcemic symptoms (four patients), a high surgical risk or an advanced age (four patients), or refusal of a surgical intervention (four patients). Before treatment, the serum concentration of ionized calcium ranged from 1.38 to 2.39 mmol/l (median, 1.59 mmol/l), and after the last treatment the serum concentration ranged from 0.80 to 1.47 mmol/l (median, 1.32 mmol/l) (p less than .001). Normocalcemia was achieved in eight patients, and evident clinical improvement was seen in seven patients. The only complication was a permanent unilateral vocal cord paralysis due to involvement of the recurrent laryngeal nerve. The present study confirms the possibility of percutaneous treatment of hyperactive parathyroid glands. However, the treatment was not found to be beneficial to all patients and hypercalcemia recurred. On the basis of our experience with these patients, we conclude that sonographically guided chemical parathyroidectomy should be considered an alternative treatment to surgery in patients who are not suited for surgical intervention.