OR30-2 Efficacy and Safety of Percutaneous Ethanol Ablation of Parathyroid Adenoma

Abstract

Introduction: Parathyroidectomy is the standard of care for the treatment of primary hyperparathyroidism (PHP). Patients who are not surgical candidates have limited options of treatment. Percutaneous ethanol injection (PEI) for the treatment of parathyroid adenoma was first introduced in the 1980s. Main safety and efficacy data about PEI of parathyroid adenoma comes from the mayo clinic review publication of the treatment of recurrent primary hyperparathyroidism in patient with MEN1. There is no large review of the treatment of PHP. In our practice, we localize the parathyroid adenoma with ultrasound in preparation for surgery. In addition, non-surgical patients who meet the criteria for treatment of hyperparathyroidism get offered the PEI as an option of treatment. All patients who were treated with PEI had FNA from the parathyroid adenoma and PTH level was measured on the aspirate to confirm the diagnosis. Study design: This is a retrospective longitudinal cohort study of calcium and PTH level in patient with PHP after PEI treatment. All patients with PHP who received PEI treatment between 2013 and 2017 electronic chart was reviewed and data was collected about calcium, PTH level before treatment and after treatment up to one year, also side effect and complication of the procedure was collected. Patient who we do not have the 6 months data we assumed treatment failure Result: Baseline characteristic 60 patients, age 34 to 95, 49 female and 11 male, PTH average 136, calcium average 11.2 Normal calcium was achieved in 39 patients (65%) at 1 week after the PEI and 36 patients (58%) at 6 months, also at 6 months the 26 patients who continued to have elevated calcium 17 of them (65%) had improvement in calcium level after the treatment and it was below 11.2. At one year we did not have lab result for all patients, out of the 36 patients who had normal calcium at 6 months we have the result of 29 patients and they continue to have normal calcium Complications from the procedure: pain in the injection site for a few minutes after injection, 4 patients (6%) had hoarseness that resolved in two weeks in 3 patients and one patient had hoarseness that persisted after one year Conclusion: This is the largest cohort of PHP patients treated with PEI and it showed 58% normalization of calcium after treatment. The main significant complication was recurrent nerve injury which was temporary in most cases