eMedicine Specialties > Radiology > Head/Neck

Parathyroid Adenoma: Follow-up

Author: Glenda Romero-Urquhart, MD, Staff Physician, Department of Radiology, Harbor Medical Center, University of California at Los Angeles
Coauthor(s): Fred S Mishkin, MD, Professor of Radiology in Residence, University of California at Los Angeles School of Medicine; Director, Division of Nuclear Medicine, UCLA-Harbor Medical Center; Panukorn Vasinrapee, MD, Assistant Clinical Professor of Radiology, University of California at Los Angeles School of Medicine, Physician Specialist in Nuclear Medicine, Department of Radiology, UCLA-Harbor Medical Center
Contributor Information and Disclosures

Updated: Apr 13, 2007

Intervention

The primary treatment for parathyroid adenomas is surgical removal via bilateral neck exploration, unilateral neck exploration, or minimally invasive, radiologically guided parathyroidectomy. Other radiologic interventions include parathyroid adenoma angiographic ablation with IV administration of contrast material and US-guided ablation with ethanol. Generally, radiologic procedures are selected when the patient is a high-risk surgical candidate.

In angiographic ablation, the feeding artery is superselectively catheterized and high-osmolar ionic contrast material is injected to induce ischemia and infarction of the gland. This procedure should be performed only if the patient is known to have other normally functioning parathyroid tissue. Otherwise, permanent hypocalcemia can occur, as Miller reported.27 Opponents of angiographic ablation base their opposition on the fact that no parathyroid tissue is available for histologic examination, no tissue is available for cryopreservation or autotransplantation, and recurrent disease is more common in these patients than in others, according to Rodriguez.16

In US-guided ethanol ablation, approximately 0.5-1 mL of 95% ethanol is injected into the parathyroid adenoma to cause tissue necrosis, as Karstrup et al reported.28 Recurrence can be a problem. The major complication is recurrent laryngeal nerve damage.

Medicolegal Pitfalls

  • Failure to determine if the patient has other normally functioning parathyroid tissue before angiographic ablation can result in permanent hypocalcemia.
  • Opponents of angiographic ablation base their opposition on the following:
    • No parathyroid tissue is available for histologic examination.
    • No tissue is available for cryopreservation or autotransplantation.
    • Recurrent disease is more common in these patients than in others.
  • Failure to consider that recurrence can be a problem with US-guided ethanol ablation.
    • The procedure may have to be repeated several times.
    • The major complication is recurrent laryngeal nerve damage.
 


More on Parathyroid Adenoma

Overview: Parathyroid Adenoma
Imaging: Parathyroid Adenoma
Follow-up: Parathyroid Adenoma
Multimedia: Parathyroid Adenoma
References
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Further Reading

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Keywords

HPT, primary hyperparathyroidism, excess parathyroid hormone, PTH, hypercalcemia, hypophosphatemia

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Contributor Information and Disclosures

Author

Glenda Romero-Urquhart, MD, Staff Physician, Department of Radiology, Harbor Medical Center, University of California at Los Angeles
Glenda Romero-Urquhart, MD is a member of the following medical societies: American College of Radiology
Disclosure: Nothing to disclose.

Coauthor(s)

Fred S Mishkin, MD, Professor of Radiology in Residence, University of California at Los Angeles School of Medicine; Director, Division of Nuclear Medicine, UCLA-Harbor Medical Center
Fred S Mishkin, MD is a member of the following medical societies: American College of Angiology, American College of Radiology, American Heart Association, American Medical Association, California Medical Association, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

Panukorn Vasinrapee, MD, Assistant Clinical Professor of Radiology, University of California at Los Angeles School of Medicine, Physician Specialist in Nuclear Medicine, Department of Radiology, UCLA-Harbor Medical Center
Panukorn Vasinrapee, MD is a member of the following medical societies: American Roentgen Ray Society, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

Medical Editor

Hussein M Abdel-Dayem, MD, Chief, Nuclear Medicine Service, Department of Radiology, Professor of Radiology, St Vincent's Catholic Medical Centers of New York
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

C Douglas Phillips, MD, Professor, Departments of Radiology, Neurosurgery, and Otolaryngology, University of Virginia Health Sciences Center
C Douglas Phillips, MD is a member of the following medical societies: American College of Radiology, American Medical Association, American Society of Head and Neck Radiology, American Society of Neuroradiology, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Consulting Staff, Department of Radiology, Virginia Mason Medical Center
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

 
 
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