Indication and efficacy of PEIT in the management of secondary hyperparathyroidism

Control of secondary hyperparathyroidism (SHPT) using active vitamin D analogues becomes difficult in advanced SHPT, because the enlarged parathyroid glands (PTGs) are resistant to medical therapy. Percutaneous ethanol injection therapy (PEIT) has been widely used in Japan since the 1990s as a surgical intervention for advanced SHPT, by selectively destroying only the enlarged glands with nodular hyperplasia (i.e. >0.5 cm(3), measured by ultrasonography). If there is only one PTG with nodular hyperplasia, PEIT will be successful with a small number of injections, and it then becomes possible to maintain target levels of parathyroid hormone by treatment with active vitamin D analogues. Recent studies have demonstrated that in the advanced phase of SHPT, it is desirable to perform PEIT when it is restricted to patients with not more than one PTG larger than 0.5 cm(3) in terms of superior prognosis can be obtained including efficacy, low recurrence, and long-term remission period.