Correction of severe secondary hyperparathyroidism in two dialysis patients: surgical removal versus percutaneous ethanol injection
| Autor: | Emile Sarfati, Tilman B. Drüeke, Jean-François Moreau, Bernard Page, Johanna Zingraff, Gérard Coutris, Jean-Claude Souberbielle |
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| Rok vydání: | 1992 |
| Předmět: |
Parathyroidectomy
Adult Male medicine.medical_specialty medicine.medical_treatment Parathyroid hormone Injections Intralesional Recurrence Renal Dialysis medicine Humans Hyperparathyroidism Ethanol business.industry Middle Aged medicine.disease Uremia Surgery medicine.anatomical_structure Nephrology Calcitonin Parathyroid Hormone Parathyroid gland Secondary hyperparathyroidism Calcium Female Hyperparathyroidism Secondary Percutaneous ethanol injection business |
| Zdroj: | American journal of kidney diseases : the official journal of the National Kidney Foundation. 19(4) |
| ISSN: | 0272-6386 |
| Popis: | Two chronic hemodialysis patients had recurrent, severe secondary hyperparathyroidism. The first had no sonographically visible parathyroid gland in the neck. Computed tomography (CT) scan indicated the existence of a parathyroid mass in the upper mediastinum, which was removed surgically. The second patient had two intracervical, hyperplastic parathyroid glands visible on ultrasound examination. He volunteered for nonsurgical removal via sonographically guided percutaneous injection of ethanol. In both patients, serum total calcium concentration decreased dramatically to values near 1.5 mmol/L 24 hours after treatment. In patient 1, serum immunoreactive parathyroid hormone (iPTH) (1–l84) decreased from 1,582 pg/mL before surgery to 34 pg/mL after 24 hours (normal range, 10 to 65 pg/mL). In contrast, serum iPTH (1–84) decreased only progressively in patient 2, from 1,680 pg/mL before ethanol injection to 865 pg/mL after 24 hours and to 378 pg/mL after 72 hours to reach 30 pg/mL after 14 days. Thus, patient 2 had a striking decrease of plasma calcium immediately after parathyroid gland destruction, even though circulating iPTH was still very high. The reason for such a discrepancy remains unexplained at present, and further study will be necessary to solve this issue. |
| Databáze: | OpenAIRE |
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