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

Abstract

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.

Fig. 1.

Serum biochemistry of all patients, separated in two groups: Group 1, Patients 1-I, 2-E and 3-N who received two or three HIFU treatments; Group 2, Patients 4-D and 5-V who received only one HIFU treatment, with a total follow-up till 90 weeks. (A–D) Graphs show changes in serum intact parathyroid hormone (A1 and A2), total calcium (B1 and B2), phosphorus (C1 and C2) and total alkaline phosphatase (D1 and D2) levels for the two groups after each HIFU treatment (black triangles).