Work

SUN-294 Treatment of Primary Hyperparathyroidism with Ethanol Ablation

Year: 2024

Type: article

Abstract: K. Kinger: None. S. Raja: None. E.D. Frontera: None. M. Evans: None. S. Warhadpande: None. R. Reinert: None. S. Saberi: None. Title: Treatment of Primary Hyperparathyroidism with Ethanol Ablation Introduction: Primary hyperparathyroidism is commonly managed via parathyroidectomy. Non-surgical management includes bisphosphonates and cinacalcet. For patients who have failed medical management and are not surgical candidates, alternative therapies such as radiofrequency ablation and ethanol ablation are being evaluated. Clinical Case: An 85-year-old male with hypercalcemia due to primary hyperparathyroidism, stage 4 chronic kidney disease, pulmonary arterial hypertension, congestive heart failure, cirrhosis, nephrolithiasis, and urothelial carcinoma status post left nephrectomy in 2013 was admitted with fatigue, falls, insomnia, and constipation suspected to be due to hypercalcemia. Eleven months prior to admission, he was evaluated by endocrine surgery and was deemed a poor candidate for parathyroidectomy due to his multiple comorbidities. He was started on cinacalcet 30 mg daily four months prior to admission, which was gradually titrated to 90 mg twice daily. On admission, serum calcium was 12.2 mg/dL (8.6-10.3 mg/dL), albumin 3.3 g/dL (3.5-4.9 g/dL), phosphorus 2.0 mg/dL (2.7-4.6 mg/dL), 25-hydroxy vitamin D 54 ng/mL (25-100 ng/mL), and PTH 419 pg/mL (10-65 pg/mL). Due to his heart failure, IV fluid was cautiously administered and cinacalcet was increased to 90 mg three times daily. His corrected calcium decreased to 11.5 mg/dL. CT neck with and without contrast demonstrated a 1.9 cm lesion posterior to the right thyroid lobe. Parathyroid sestamibi scan demonstrated increased focal radiotracer uptake in the right tracheoesophageal groove consistent with parathyroid adenoma. Due to the size of the parathyroid adenoma, recurrent hospitalization for hypercalcemia, and degree of hypercalcemia at presentation, he underwent ethanol ablation of the parathyroid adenoma. Post ablation, cinacalcet was reduced to 90 mg twice daily. His serum calcium decreased to 9.9 mg/dL eleven days after ablation. Clinical lessons: In patients who are symptomatic, have failed medical management, and are not surgical candidates, ethanol ablation can be considered as a therapeutic option for primary hyperparathyroidism. Sunday, June 2, 2024

Source: Journal of the Endocrine Society

DOI: 10.1210/jendso/bvae163.2326