Singh Ospina Naykky, Thompson Geoffrey B, Lee Robert A, Reading Carl C, Young William F
Division of Endocrinology, Diabetes, Metabolism, and Nutrition, and Department of Internal Medicine (N.S.O., W.F.Y.), Division of Endocrine Surgery and Department of Surgery (G.B.T.), and Department of Radiology (R.A.L., C.C.R.), Mayo Clinic, Rochester Minnesota 55905.
J Clin Endocrinol Metab. 2015 Jan;100(1):E87-90. doi: 10.1210/jc.2014-3255.
The most common feature of multiple endocrine neoplasia type 1 (MEN1) is primary hyperparathyroidism (PHP), which occurs in approximately 95% of MEN1 patients. Approximately 40-60% of patients with MEN1 develop recurrent hypercalcemia within 10-12 years after their initial parathyroid surgery and the successful management of recurrent PHP is challenging.
This study sought to evaluate the safety and efficacy of percutaneous ethanol ablation (PEA) for the treatment of recurrent PHP in patients with MEN1. DESIGN, SETTING, PATIENTS, INTERVENTION, OUTCOME MEASURED: We performed an electronic search to identify patients with a billing code for MEN1 who were seen at Mayo Clinic between 1977 and 2013. Patients with recurrent PHP who underwent PEA were identified and their clinical information was collected. We performed t test analyses to compare mean values.
Thirty-seven patients underwent 80 PEA treatments that included 123 sessions of ethanol administration. Twenty-one patients were women (56.8%) and the mean age at diagnosis of PHP was 33.8 years. The mean preprocedure calcium level was 10.7 mg/dl ± 0.57 (SD) and the mean postprocedure calcium level was 9.6 mg/dl ± 0.76 (P < .01). In 14 treatments (18.9%) the postprocedure calcium was greater than 10.1 mg/dl. Postprocedure hypocalcemia occurred in six treatments (8.1%). Normocalcemia was achieved in 54 of the treatment episodes (73%) and the mean duration of normocalcemia was 24.8 months. PEA was safe with transient hoarseness occurring in four of the treatments (5%).
The treatment of recurrent PHP in patients with MEN1 represents a challenge that is associated with increased morbidity. PEA is an effective treatment option for achieving normocalcemia in the majority of the patients with MEN1. PEA is associated with low rates of hypocalcemia and no permanent complications.
多发性内分泌腺瘤1型（MEN1）最常见的特征是原发性甲状旁腺功能亢进（PHP），约95%的MEN1患者会出现该症状。约40%-60%的MEN1患者在首次甲状旁腺手术后10-12年内会出现复发性高钙血症，而复发性PHP的成功管理具有挑战性。
本研究旨在评估经皮乙醇消融（PEA）治疗MEN1患者复发性PHP的安全性和有效性。设计、设置、患者、干预、测量结果：我们进行了电子检索，以识别1977年至2013年间在梅奥诊所就诊且有MEN1计费代码的患者。确定接受PEA治疗的复发性PHP患者，并收集他们的临床信息。我们进行t检验分析以比较平均值。
37例患者接受了80次PEA治疗，其中包括123次乙醇注射。21例患者为女性（56.8%），PHP诊断时的平均年龄为33.8岁。术前平均血钙水平为10.7mg/dl±0.57（标准差），术后平均血钙水平为9.6mg/dl±0.76（P<.01）。14次治疗（18.9%）术后血钙大于10.1mg/dl。6次治疗（8.1%）出现术后低钙血症。54次治疗（73%）实现了血钙正常，血钙正常的平均持续时间为24.8个月。PEA安全，4次治疗（5%）出现短暂性声音嘶哑。
MEN1患者复发性PHP的治疗是一项具有挑战性的任务，且发病率增加。PEA是使大多数MEN1患者实现血钙正常的有效治疗选择。PEA导致低钙血症的发生率低，且无永久性并发症。
