Redefining Definitive Therapy: Percutaneous Ethanol Ablation for Primary Hyperparathyroidism in a Nonsurgical Candidate
https://doi.org/10.15605/jafes.041.S1
- Author:
Thunissha Manoharan
1
;
Yueh Chien Kuan
1
;
Pei Lin Chan
2
;
Whilmore Johin
3
;
Dhayal Balakrishnan
3
Author Information
1. Endocrine Unit, Miri General Hospital
2. Endocrine Unit, Sarawak General Hospital
3. Radiology Department, Sarawak General Hospital
- Publication Type:Journal Article
- MeSH:
Hyperparathyroidism, Primary;
Ethanol
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):69-70
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Parathyroidectomy is the definitive treatment for primary
hyperparathyroidism (PHPT) due to parathyroid adenoma.
However, surgery may be contraindicated in patients with
significant comorbidities. Ultrasound-guided percutaneous
ethanol ablation (PEA) is a minimally invasive alternative
that induces biochemical remission through targeted
destruction of hyperfunctioning tissue. We report a case of
PHPT successfully managed with PEA in a patient unfit for
surgery due to cardiac dysfunction.
Case:In 2023, a 53-year-old female with stage IB breast carcinoma was found to have persistent hypercalcemia (2.68–
3.59 mmol/L) during chemotherapy and post-mastectomy
follow-up. Evaluation excluded bone metastases. Biochemical assessment demonstrated elevated intact parathyroid hormone (iPTH) levels 38.6 pmol/L (Reference:
1.6–6.0 pmol/L), hypophosphatemia (0.42–0.80 mmol/L),
and elevated alkaline phosphatase (ALP) 215–309 U/L
(30–120 U/L)—consistent with PHPT. Tc-99 m sestamibi
scintigraphy localized a 1.1 × 1.5 × 1.2 cm hyperfunctioning
parathyroid adenoma.
Initial management prioritized oncological therapy,
including trastuzumab for 1 year. Hypercalcemia was
intermittently controlled with intravenous hydration and
zoledronic acid when calcium exceeded 3 mmol/L.
Her disease was complicated with severe osteoporosis
(DEXA T-score −3.3) with vertebral fractures, renal impairment requiring cessation of alendronate, and medullary
nephrocalcinosis on computed tomography surveillance. Following completion of cancer therapy, she was evaluated
for parathyroidectomy. Preoperative assessment revealed
NYHA class II heart failure, with reduced ejection fraction
(36%) and severe tricuspid regurgitation attributed to
trastuzumab-related cardiomyopathy. Despite optimal
medical therapy, she was deemed high-risk for surgery.
Cinacalcet failed to achieve sustained calcium control with
levels exceeding 3 mmol/L. She was therefore referred
for PEA.
Post-procedure, iPTH decreased 80% by Day 5 (54.9–10.6
pmol/L), with sustained normocalcemia (2.25 mmol/L) at
10 days without further need for cinacalcet.
Conclusion:This case illustrates that PEA can serve as definitive therapy
for PHPT in patients unsuitable for surgery. It provides
rapid and sustained biochemical control, while avoiding
operative risk, supporting its role in individualized
management.
- Full text:2026080317143552356EP_A091.pdf
