Acute Hypoparathyroidism after Percutaneous Fine-Needle Ethanol Injection (PFNEI) in a Patient on Haemodialysis

Dr. Pier Luigi Bedani, Division of Nephrology, S. Anna Hospital, Corso Giovecca 203, I-44100 Ferrara (Italy) Dear Sir, Percutaneous fine-needle ethanol injection (PFNEI) is a valid procedure for the treatment of secondary hyperparathyroidism (sHPT) in uraemic patients undergoing chronic dialysis, particularly when parathyroid hyperactivity recurs after subtotal para-thyroidectomy (PTX) [13]. The side-effects of PFNEI are limited (remitting local pain, transient dysphonia, light parathyroid swelling owing to oedema or haematoma) and usually do not promote acute changes in serum calcium and phosphorus concentrations, because the correction of sHPT is slow and progressive [2, 3]. We report a case of acute hypoparathyroidism after PFNEI of an enlarged parathyroid gland in a haemodialyzed patient who had been previously submitted to subtotal PTX. Case Report A 38-year-old woman on RDT for 35 months because of chronic glomerulonephri-tis had been submitted to PTX for severe sHPT. Histological study had confirmed the removal of three parathyroid glands, i.e. the two apical and the lower left. The day after the operation, the patient had a transient light hypocalcaemia favourably corrected by oral calcium and calcitriol administration. A few months later, the patient experienced muscu-loskeletal pains, symptoms of polyneuropa-thy, persistent hyperphosphataemia, which could not be corrected by overdoses of aluminium-containing phosphate binders, and very elevated serum alkaline phosphatase (1,280 U/l; reference interval 99-310 U/l). Fig. 1. Acute changes in the serum PTH (•), calcium (Ca, ¤), phosphorus (P, ■) and alkaline phosphatase (ALP, O) after the second percutaneous ethanol injection. Sonographic study of the anterior region of the neck showed an enlarged gland on the right basal side. An ultrasonically guided fine-needle aspiration biopsy was performed, but histological study indicated, erroneously, the presence of thyroid tissue. Some months later, with persisting bone pain and intractable pruritus, due to hyperphosphataemia (7.5-8.2 mg/dl, 2.5-2.7 mmol/l; reference intervals 2-5 mg/ dl, 0.7-1.7 mmol/l) and elevated Ca × P product (75-80 mg/dl), the patient underwent an MNR of the neck which showed the presence ofa lower right enlarged parathyroid gland. A further fine-needle aspiration biopsy was performed. The cytological examination confirmed