| [ Summary ] |
Marked parathyroid hyperplasia is one of the characteristic features of severe hyperparathyroidism in patients requiring chronic hemodialysis. Most of these patients become resistant to conservative therapies, including calcitriol pulse therapy. For these patients, surgical removal of the enlarged parathyroid glands is usually necessary to control parathyroid hormone secretion. Recently, hyperparathyroidism in some of these patients has been managed by percutaneous ethanol injection therapy (PEIT) in conjunction with developments in imaging technology. However, PEIT has the risk of producing adverse reactions such as recurrent nerve palsy, difficult PTx after PEIT and is ineffective in some cases. In this paper we consider strategies for treatment of severe hyperparathyroidism using PTx, PEIT and conservative therapies. |