Abstract
A 42-year-old woman with secondary hyperparathyroidism who had been undergoing hemodialysis for 12 years developed progressive bone pain. Vitamin D3 pulse therapy was administered, because the patient refused parathyroidectomy. Pulse therapy was discontinued, however, because of hypercalcemia. Congestive heart failure of obscure origin later developed.
When it proved refractory to adequate dialysis and excess fluid removal, an adrenergic beta-blocker (metoprolol) was administered, and ultrasonically guided percutaneous ethanol injection of the parathyroid glands was performed. This was followed by a marked reduction in heart size and serum parathyroid hormone levels, and improvement in the patient's clinical condition was noted. Continued treatment resulted in increased physical capacity. Combination therapy consisting of percutaneous ethanol injection and a beta-blocker can be useful in the treatment of secondary hyperparathyroidism complicated by congestive heart failure when surgery is refused or problematic.
