Surgery is the usual treatment for
primary hyperparathyroidism. However, some patients with high surgical risks are not suitable for surgery. For such patients, we propose, as an alternative treatment, ultrasonically guided percutaneous
ethanol injection into
parathyroid adenomas, in order to induce
necrosis of the
tumor. We report, here, the results of ultrasonically guided percutaneous
ethanol injection into
parathyroid adenomas, during a prolonged follow-up period up to 49 months, in a group of 13 patients (median age 79 years) with
primary hyperparathyroidism and
contraindications for surgery. In seven patients, complete normalization of plasma
calcium,
phosphorus and
parathyroid hormone (PTH) levels was achieved after
ethanol injections, with no recurrence of
hypercalcemia during a median follow-up period of 28 months (total success). In these seven patients, plasma
calcium,
phosphorus and PTH levels were normalized 48 h after the successful
ethanol injection. In four patients, a partial success was obtained with clinical improvement and normalization of plasma
calcium levels but without complete normalization of plasma PTH levels. This partial success is due to incomplete
necrosis of the
adenoma, as has been confirmed in one patient by histopathological examination. The
ethanol injection treatment failed in only two patients. This treatment was always well tolerated and no major side-effects were observed. In conclusion, our results give evidence that ultrasonically guided percutaneous
ethanol injection into
parathyroid adenomas can be a very useful alternative
therapy in patients not suitable for surgery.