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Anh TTH, My LT, Tu NTT, Hiep PV, My TTT. Hyperparathyroidism with acute pancreatitis in elderly patient treated by radiofrequency ablation: A case report. Radiol Case Rep 2024; 19:2438-2442. [PMID: 38585396 PMCID: PMC10997866 DOI: 10.1016/j.radcr.2024.02.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/18/2024] [Accepted: 02/25/2024] [Indexed: 04/09/2024] Open
Abstract
Acute pancreatitis as an initial manifestation of primary hyperparathyroidism (PHPT) has been rarely reported. We report a case of acute pancreatitis from a hyperfunctioning parathyroid tumor in an 87-year-old woman with drowsy state. Laboratory tests showed high lipase, calcium, and intact parathyroid hormone level, and abdominal computed tomography scan revealed acute pancreatitis. Neck ultrasound and scintigraphy gave rise to the diagnosis of primary hyperparathyroidism due to a left parathyroid tumor. The patient underwent radiofrequency ablation of the parathyroid tumor. After the procedure, symptoms subsided and patient was discharged from the hospital 2 weeks later. Six months of treatment, the PTH and calcium serum significantly reduced, her clinical presentation was stable, and there were no signs or symptoms of recurrence pancreatitis.
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Affiliation(s)
| | | | | | | | - Thieu Thi Tra My
- Radiology department, Vinmec Times City International hospital, Ha Noi, Viet Nam
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Liu Z, Zhao Y, Han X, Hu X, Zhang Y, Xu L, Chen G, Liu C, Xu S. Ultrasound-guided microwave ablation in the treatment of recurrent primary hyperparathyroidism in a patient with MEN1: a case report. Front Endocrinol (Lausanne) 2023; 14:1175377. [PMID: 37795364 PMCID: PMC10546301 DOI: 10.3389/fendo.2023.1175377] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023] Open
Abstract
Background Multiple endocrine neoplasia type 1 (MEN1) is an inherited endocrine syndrome caused by the mutation in the tumor suppressor gene MEN1. The recurrence rate of primary hyperparathyroidism (PHPT) in patients with MEN1 after parathyroidectomy remains high, and the management of recurrent hyperparathyroidism is still challenging. Case presentation We reported a 44-year-old woman with MEN1 combined with PHPT who was diagnosed through genetic screening of the patient and her family members. After parathyroidectomy to remove one parathyroid gland, the patient suffered from persistent high levels of serum calcium and parathyroid hormone, which returned to normal at up to 8 months after ultrasound-guided microwave ablation (MWA) for bilateral parathyroid glands, suggesting an acceptable short-term prognosis. Conclusion Ultrasound-guided MWA for parathyroid nodules may be an effective therapeutic strategy for recurrent PHPT in MEN1 patients.
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Affiliation(s)
- Zhoujun Liu
- Endocrine and Diabetes Center, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Yueting Zhao
- Endocrine and Diabetes Center, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Xue Han
- Endocrine and Diabetes Center, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Xin Hu
- Endocrine and Diabetes Center, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Yuzhi Zhang
- Department of Ultrasound, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Lan Xu
- Department of Endocrinology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Guofang Chen
- Endocrine and Diabetes Center, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
- Key Laboratory of Tradtional Chinese Medicine Syndrome & Treatment of Yingbing (Thyroid Disease) of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Chao Liu
- Endocrine and Diabetes Center, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
- Key Laboratory of Tradtional Chinese Medicine Syndrome & Treatment of Yingbing (Thyroid Disease) of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Shuhang Xu
- Endocrine and Diabetes Center, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
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Rank K, Lynch AM, Green R, Reed-Jones L, Harrell K, Ueda Y. Case report: Laryngospasm following ethanol ablation of a parathyroid nodule in a dog with primary hyperparathyroidism. Front Vet Sci 2023; 10:1201663. [PMID: 37397006 PMCID: PMC10310404 DOI: 10.3389/fvets.2023.1201663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/25/2023] [Indexed: 07/04/2023] Open
Abstract
A 12-year-old female spayed dachshund was presented for emergency assessment of respiratory distress, characterized by inspiratory dyspnea with stridor. Percutaneous ultrasound-guided ethanol ablation of a functional parathyroid tumor was performed 72-h earlier for management of primary hyperparathyroidism. The dog was hypocalcemic (ionized calcium 0.7 mmol/L, reference interval: 0.9-1.3 mmol/L) at the time of presentation and had evidence of laryngospasm on a sedated oral exam. The dog was managed conservatively with supplemental oxygen, anxiolysis, and parenteral calcium administration. These interventions were associated with rapid and sustained improvement in clinical signs. The dog did not demonstrate any recurrence of signs afterwards. To the authors' knowledge, this is the first description of laryngospasm following ethanol ablation of a parathyroid nodule in a dog that developed hypocalcemia.
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Combination Therapy of Ethanol Ablation and Radiofrequency Ablation to Treat Parathyroid Adenoma in a Case with Primary Hyperparathyroidism. IRANIAN JOURNAL OF RADIOLOGY 2022. [DOI: 10.5812/iranjradiol-120869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Introduction: Ethanol ablation (EA) and radiofrequency ablation (RFA) are minimal invasive therapeutic modalities to treat primary hyperparathyroidism (PHPT). Case Presentation: A 77-year-old man presented a 3.5-cm parathyroid adenoma with mixed cystic and solid components. He was ineligible for parathyroidectomy because of his age and the surgical history of the coronary artery bypass graft. First, EA was performed to remove cystic component. After that, the volume of parathyroid adenoma was decreased (volume reduction rate: 94%); however, the level of serum parathyroid hormone (PTH) was persistently high (88 pg/mL). Subsequent RFA was performed to remove the remaining parathyroid adenoma. Further, it was completely disappeared on the following ultrasound examination, and PTH was normalized. The results during a 2-year follow-up confirmed clinical success, and no relevant complication was reported. Conclusion: The combination therapy of EA and subsequent RFA is safe and effective as an alternative therapeutic method to treat PHPT in patients ineligible for parathyroidectomy.
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Efficacy and safety of radiofrequency ablation versus parathyroidectomy for secondary hyperparathyroidism in dialysis patients: a single-center retrospective study. Sci Rep 2022; 12:10289. [PMID: 35717444 PMCID: PMC9206661 DOI: 10.1038/s41598-022-14623-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 06/09/2022] [Indexed: 11/08/2022] Open
Abstract
We compared the efficacy and safety of ultrasound (US)-guided radiofrequency ablation (RFA) and parathyroidectomy (PTX) for the treatment of secondary hyperparathyroidism (SHPT). In this single-center retrospective study, we divided patients into PTX (n = 53) and RFA (n = 47) groups. The primary outcome was the proportion of patients who achieved the target intact parathyroid hormone (iPTH) concentration range (≤ 300 pg/mL). Secondary outcomes were the differences in the changes in iPTH, calcium, and phosphorus levels over time and prognosis. iPTH concentrations of 82.1% and 64.1% in the PTX and RFA groups, respectively, were within the recommended range at the endpoint (P = 0.07). iPTH concentrations in the PTX and RFA groups dropped sharply after treatment (82 ± 163 pg/mL and 280 ± 307 pg/mL, respectively, P < 0.001). There was no difference in the trends of iPTH, calcium, and phosphorus levels between the two groups (P > 0.05). Survival analysis revealed no differences in all-cause mortality and cumulative response rate between the two groups (P = 0.90, P = 0.14, respectively). Notably, the incidence of infection and length of the hospital stay in the RFA group were significantly lower. The preoperative bone-specific alkaline phosphatase concentration was a risk factor for postoperative hypocalcemia. US-guided RFA is minimally invasive and compared to PTX in terms of long-term efficacy and complications in the treatment of severe SHPT in maintenance dialysis patients. It may be used as an alternative technique to PTX; however, further studies are needed.
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Evaluation of the Early Results of Percutaneous Ethanol Ablation in Patients with Primary Hyperparathyroidism. ACTA MEDICA BULGARICA 2022. [DOI: 10.2478/amb-2022-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Percutaneous ethanol ablation (PEA) is an alternative non-surgical method for the treatment of patients with primary hyperparathyroidism (PHPT), suitable in cases with comorbidities and high surgical risk.
The aim of the present study was to evaluate the results of PEA in patients with PHPT at the early stages of follow-up.
Materials and methods: The study included 35 patients (30 women and 5 men, mean age 59.7 ± 12.4 years) with biochemical and hormonal data of PHPT and localized parathyroid adenoma (PTA) by ultrasound, nuclear scan, FNB with cytology and evaluation of PTH in the needle washout. All patients were at high surgical risk or refused surgical treatment. PEA was applied and changes in the PTA volume and calcium-phosphate metabolism were monitored at the third (M3) and sixth (M6) months after the procedure.
Results: Normocalcaemia was achieved in 26 patients (74.3%) at M3 and persisted at M6 in 22 of them. A second course of PEA was administered in 11 patients with persistent hypercalcaemia at M3 and M6, respectively. Compared to the baseline, the mean PTA volume decreased significantly by 53% at M3 and 67% at M6 (p < 0.001). Side effects including local pain, edema and dysphonia were observed in 5 patients (14.3%).
Conclusion: PEA is an efficient and safe treatment modality for the management of PHPT. A significant reduction in PTA volume and a normalization of serum calcium and PTH levels were observed at the early stages of follow-up.
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Karunaratne D, Owens E, Kirkland P, Zainab Al SA, Howlett D. Metastatic parathyroid cancer: a rare cause of hypercalcaemia. BMJ Case Rep 2021; 14:e244302. [PMID: 34711621 PMCID: PMC8557304 DOI: 10.1136/bcr-2021-244302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2021] [Indexed: 11/04/2022] Open
Abstract
A 45-year-old man presenting with abdominal pain was found to have severe hypercalcaemia with elevated parathyroid hormone. Investigations revealed a parathyroid mass and bone metastases consistent with metastatic parathyroid carcinoma. The patient underwent parathyroidectomy, with histology confirming a right inferior parathyroid carcinoma. His postoperative management was complicated by severe hypercalcaemia refractory to medical therapy, owing to the metastases continuing to produce parathyroid hormone. Despite palliative radiotherapy to the metastases, the patient died within 3 months from end-organ failure related to hypercalcaemia.
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Affiliation(s)
| | - Emma Owens
- Radiology, Eastbourne DGH, Eastbourne, UK
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Li X, Tufano RP, Russell JO, Yan L, Xiao J, Li Y, Zhang M, Luo Y. Ultrasound-guided radiofrequency ablation for the treatment of primary hyperparathyroidism: An efficacy and safety study. Endocr Pract 2021; 27:1205-1211. [PMID: 34311118 DOI: 10.1016/j.eprac.2021.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of radiofrequency ablation (RFA) for the treatment of primary hyperparathyroidism (pHPT). METHODS 25 patients who were treated with RFA for pHPT from September 2015 to January 2020 were enrolled in our study. The serum intact parathyroid hormone (iPTH), calcium and phosphate levels were tested within 1 week before RFA and at 1 day, 1 month, 3months, 6months and 12months after ablation. The ablation areas were evaluated by US at 1, 3, 6 and 12 months after RFA. Postoperative complications including voice hoarseness, hematoma, postoperative pain, incision infections, hypoparathyroidism and hypocalcemia were recorded. RESULTS A total of 25 pHPT patients (53.9 ± 10.9 years, 22 women and 3 men) with 29 enlarged parathyroid glands were treated by RFA. 22 of them were treated in one session and the other three were treated in two sessions. Serum iPTH and calcium levels decreased significantly at 1 day after RFA (all P < 0.05). 21 patients had normal levels of serum iPTH and calcium after RFA, with a cure rate of 84%. 26 treated parathyroid glands exhibited a volume reduction rate greater than 70% at the 12 months follow-up. There were only some minor complications, including four postoperative pain (4/25, 16%) and one mild postoperative transient hypocalcemia (1/25, 4%). CONCLUSIONS US-guided RFA is an effective and safe technique for the treatment of carefully selected patients with pHPT. Larger sample size and longer follow-up are still need to further confirm its clinical value.
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Affiliation(s)
- Xinyang Li
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin 300071, China; Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Ralph P Tufano
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, Maryland, the United States of America
| | - Jonathon O Russell
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, Maryland, the United States of America
| | - Lin Yan
- Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Jing Xiao
- Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Yingying Li
- Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Mingbo Zhang
- Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China.
| | - Yukun Luo
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin 300071, China; Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China.
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