Management of a Parathyroid Adenoma With Radiofrequency Ablation: A Case Report

Abstract

Introduction: The standard treatment for symptomatic primary hyperparathyroidism due to parathyroid adenoma is surgery, but in patients who are not good candidates for surgery, other treatment modalities including ethanol ablation, laser ablation, ultrasound wave ablation, and radiofrequency ablation are used. We describe a patient with multiple medical problems and a parathyroid adenoma who was treated with radiofrequency ablation. Case Presentation: A 47-year-old patient was referred to our hospital (Namazi hospital, Shiraz, Iran) in April, 2015 with intracranial hemorrhage, as well as high serum calcium and PTH (parathyroid hormone) levels (12.1 mg/dL and 1062 pg/mL, respectively), who had a parathyroid adenoma. Radiofrequency ablation was performed for the patient after he was stabilized, and three days later, his serum calcium and PTH levels decreased to 8.9 mg/dL and 38 pg/mL, respectively, and there was abnormal uptake according to the post-ablation parathyroid scan. The patient was followed for 12 months in our endocrine clinic, during which time he was in good general condition, with normal serum calcium, phosphate, and parathyroid hormone levels. Conclusions: Radiofrequency ablation may be used successfully in the treatment of parathyroid adenoma when a patient cannot tolerate surgery.

Radiofrequency Ablation of Parathyroid Adenoma: A Novel Treatment Option for Primary Hyperparathyroidism

“…The patient had normal serum iPTH and calcium levels at the end of 2-year follow-up. There were no complications in our case, with low complication rates similar to those reported in the literature, 5,[14][15][16][17][18][19][20] suggesting that with appropriate training, this a relatively safe procedure. Operator experience likely plays a role in the complication rate.…”

“…Nine reports were identified that described 32 cases of PHPT treated with RFA (Table ). 5,[14][15][16][17][18][19][20][21] In these cases, RFA was performed because of either contraindication to surgery or the patient refusing surgery, and there was limited follow-up. Of note, in 1 case, RFA was performed inadvertently when a parathyroid adenoma was mistaken for a thyroid nodule; this was the only case where there was no improvement in biochemical profile.…”

Radiofrequency ablation as a treatment modality for primary hyperparathyroidism: a systematic literature review

“…Most of the RFA patients either declined to undergo parathyroidectomy (e.g., anxiety or fear of surgical scar) or were deemed poor candidates for surgical management due to their comorbidities ( 12 - 15 , 18 - 20 , 22 , 24 - 27 ). Several comorbidities described included patients with a history of deep vein thrombosis ( 13 ), heart failure ( 22 ), heart disease ( 19 ), brain damage ( 26 ), chronic vascular conditions ( 19 ), and/or acute necrotizing pancreatitis ( 13 ).…”