Abstract
ObjectiveTo assess the efficacy and safety of ultrasound-guided microwave ablation (MWA) in the treatment of primary hyperparathyroidism (PHPT), and to investigate whether MWA can improve the bone turnover and renal function.MethodsA total of 20 consecutive PHPT patients with 21 parathyroid lesions treated with MWA in our center from May 2019 to March 2021 were recruited in this study. Serum parathyroid hormone (PTH), calcium and phosphorus levels before MWA and at 20 minutes, 4 hours, 1 day, 3 months, 6 months and 12 months after MWA were measured. Bone turnover biomarkers, renal function and lesion volume with volume reduction rate (VRR) before MWA and at the last follow-up were compared. Any complication related with MWA was evaluated. The technical and clinical success rates of MWA in the treatment of PHPT were calculated. Clinical success was defined as normal serum PTH and calcium without PHPT-associated manifestations at more than 6 months after ablation. Technical success was defined as complete ablation indicated by immediate postoperative contrast-enhanced ultrasound.ResultsThe serum PTH, calcium and phosphorus levels at their respective follow-up time points dropped significantly after MWA (P <0.05). The volume of parathyroid lesions at the final examination was significantly reduced, compared with pre-ablation volume (P <0.001), with a median VRR reaching 89%. The technical and clinical success rates were 100% and 63.6%, respectively. Substantial changes of bone turnover biomarkers were observed before and after MWA (P <0.05), but the differences in renal function were not statistically significant. No major complications were reported in all cases. Pre-MWA serum PTH, lesion volume, maximum diameter of lesion and ablation time were significantly different between patients with successful and failed MWA.ConclusionsPHPT can be effectively and safely treated by ultrasound-guided MWA, as proven by drop in serum PTH and reduction in the volume of parathyroid adenomas. Besides, MWA can impede bone remodeling to suppress hyperparathyroidism in the condition of PHPT.
Highlights
Primary hyperparathyroidism (PHPT) is an endocrine disease caused by excessive secretion of parathyroid hormone (PTH) from one or more of the four parathyroid glands, manifesting elevated or normal serum calcium levels
We aimed to investigate the changes in PTH, serum calcium and volume of ablated lesions in PHPT patients, as well as evaluate skeletal and renal functions to further evaluate the efficacy and safety of ultrasound-guided microwave ablation (MWA) in the treatment of PHPT
According to the inclusion and exclusion criteria, eligible patients with parathyroid adenoma-induced PHPT treated with MWA in the Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine from May 2019 to March 2021 were recruited in this study
Summary
Primary hyperparathyroidism (PHPT) is an endocrine disease caused by excessive secretion of parathyroid hormone (PTH) from one or more of the four parathyroid glands, manifesting elevated or normal serum calcium levels. Classical PHPT presents with a symptomatic, multiple system dysfunction, especially skeletal and renal damages. As one of the commonly used calcimimetics, cinacalcet is unable to significantly improve bone mineral density (BMD) and urinary calcium excretion, it does lower serum calcium level [5]. It often induces adverse events like headache, nausea and vomiting. PHPT patients had higher a risk of fracture compared with healthy controls, especially in the forearm and spine sites. The risks of vertebral fractures were more than four times higher in PHPT patients than in those without skeletal and renal damages [8]. An early intervention of PHPT, even in mild condition (serum calcium
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