CURATIVE TREATMENT OF PRIMARY HYPERPARATH YROIDISM BY SUBCUTANEOUS INJECTION OF ETHANOL

History and Clinical findings: An 86-year-old woman was admitted becau se of acute nonspecific upper abdominal symptoms and vomiting. She was occasionally disoriented, generally slower in movement and reaction, apathetic and mainly bed-ridden. She was a known insulin-dependent dia betic who had sustained a posterior wall myocardial infarction and cer ebrovascular accident and had undergone a cholecystectomy. On physical examination her upper abdomen was painful to pressure, blood pressure was 180/95 mm Hg, but there were no other findings. Investigations: S onography demonstrated bile-duct dilatation, confirmed at endoscopic r etrograde cholangiopancreatography, and a prepapillary choledochal con crement of about 10 mm. Sonography also reveal ed an echo-poor tumour of the right caudal parathyroid. The calcium concentration was raised to 2.94- 3.16 mmol/l and the parathormone level was also increased (99 .5 pmol/l, normal 1.2-5.7 pmol/l), as were amylase (375,6 U/l) and lip ase (1038-5394 U/l). Treatment and course: After papillotomy and extra ction of the choledochal concrement the acute biliary pancreatitis qui ckly improved. Operation on the parathyroid tumour was not undertaken because of the patient's various illnesses. Instead, 95% alcohol was i nstilled, 3.5 and 4.5 ml respectively, into the tumour, under sonograp hic control in two sessions, 3 days apart. Her clinical condition clea rly improved and serum calcium became normal and the parathormone leve l fell significantly. Conclusion: Percutaneous ethanol infection of a parathyroid tumour can be a curative and sparing alternative to operat ion in patients with hyperparathyroidism seemed too ill for surgery.