Percutaneous Ethanol Injection Therapy for Secondary Hyperparathyroidism in an Elderly Tracheostomized Hemodialysis Patient

Hyperparathyroidism, either secondary or tertiary, is a major complication of end stage renal disease (ESRD). It can result in renal bone disease if left untreated. Although surgical parathyroidectomy remains the treatment of choice, the appropriate therapy to treat hyperparathyroidism in specific patient groups such as tracheostomized patients has not been elucidated. We present a case of secondary hyperparathyroidism (SHPT) in a tracheostomized chronic hemodialysis patient. Surgical intervention with parathyroidectomy was indicated due to the poor response to medical treatment; however, in light of the surgical and anesthesia-related risks, the patient was referred for percutaneous ethanol injection therapy (PEIT). After 6 sessions of PEIT, her serum levels of intact parathyroid hormone, total calcium, and phosphate showed an apparent improvement and remained within the range proposed by the kidney disease outcomes quality initiative guidelines until the end of the treatment course without complications. Therefore, PEIT might be a suitable treatment for SHPT, even in elderly tracheostomized hemodialysis