US-guided high-intensity focused ultrasound as a promising non-invasive method for treatment of primary hyperparathyroidism.

OBJECTIVES: To investigate the long-term efficacy and safety of ultrasound (US)-guided high-intensity focused ultrasound (HIFU) treatment in patients with primary hyperparathyroidism (PHPT). METHODS: In our prospective study, 13 of 72 screened patients with PHPT were eligible for HIFU treatment, which was performed in one or two sessions. Parathyroid adenoma size and function were evaluated at baseline, 1, 3, 6, 9, and 12 months after the final HIFU session. RESULTS: In 11 females and 2 males, mean age 55.2 ± 12.41 years, the mean applied energy was 15.2 ± 7.7 kJ. Parathyroid size and parathyroid hormone decreased significantly one month after HIFU therapy (p < 0.002 and p < 0.02, respectively). Calcium concentration decreased slowly to reach significant reduction nine months later (p < 0.05). Complete remission was noted in three patients (23%) after one year, good disease control was achieved in nine (69%), and procedure was unsuccessful in one patient (8%). Number of sessions was significantly related to treatment success (p < 0.05). Transitory side effects were impaired vocal cord mobility in three patients (23.1%), subcutaneous oedema in three patients (23.1%), and a combination of both in two patients (15.4%). CONCLUSIONS: HIFU is a promising non-invasive technique for PHPT treatment, which could serve as therapeutic alternative for selected patients. KEY POINTS: US-guided HIFU is a new non-invasive ablative technique for parathyroid adenomas. The method is efficient and ensures good disease control in most patients. HIFU is a good alternative for patients not meeting surgery criteria. Treatment is well-tolerated with only transient side effects.

High-intensity focussed ultrasound (HIFU) treatment in uraemic secondary hyperparathyroidism.

BACKGROUND: The recently developed non-invasive high-intensity focussed ultrasound (HIFU) technique for the destruction of parathyroid adenomas could also be of interest for the treatment of secondary hyperparathyroidism (SHP) in patients with chronic kidney disease (CKD). We conducted a pilot study using this method. METHODS: Five chronic haemodialysis patients with severe SHP underwent one to three HIFU treatments, respectively. They had at least one or two enlarged parathyroid glands, which were accessible to this technique. RESULTS: In Patients 1-I and 5-V, serum intact parathyroid hormone (iPTH) could be successfully reduced in the long run. In Patient 3-N, serum iPTH decreased dramatically down to the normal range but increased again subsequently. In Patients 2-E and 4-D, transient reductions in serum iPTH were also obtained but HIFU failed to correct SHP during follow-up. Serum total calcium and phosphorus decreased in four among the five patients, either transiently or permanently. Serum total alkaline phosphatases were reduced in four of five patients. Side effects included local oedema, transient impairment of vocal cord mobility and bitonal voice. CONCLUSIONS: HIFU treatment may be of help in controlling SHP in selected patients with CKD. Further experience is clearly needed.