Treatment of primary hyperparathyroidism in a Miniature Horse using chemical ablation of abnormal parathyroid tissue localized by 3-phase computed tomography.
Authors: Colmer Sarah F, Wulster Kathryn, Johnson Amy L, Levine David G, Underwood Claire, Watkins Trevor W, Van Eps Andrew W
Journal: Journal of veterinary internal medicine
Summary
# Editorial Summary: Chemical Ablation for Equine Primary Hyperparathyroidism Primary hyperparathyroidism is a rare endocrine disorder in horses characterised by autonomous parathyroid hormone secretion, leading to elevated serum calcium levels and associated complications including soft tissue mineralisation and potential cardiac arrhythmias. This case report documents the diagnostic and therapeutic management of a 15-year-old Miniature Horse mare presenting with persistently elevated total and ionised plasma calcium alongside raised parathyroid hormone concentrations; localisation of abnormal parathyroid tissue was achieved through a combination of ultrasonography, sestamibi nuclear scintigraphy, and 3-phase computed tomography, with the latter providing superior anatomical definition for procedural planning. Rather than pursuing conventional surgical parathyroidectomy, the clinicians performed percutaneous ultrasound-guided ethanol ablation under general anaesthesia—a minimally invasive technique previously unreported in equine medicine—which resulted in rapid normalisation of ionised calcium and parathyroid hormone concentrations within the post-operative period. Whilst surgical resection remains the gold standard for hyperparathyroidism management, this case suggests that chemical ablation may offer a viable alternative in equine patients where precise pre-operative localisation is possible and surgical access is technically challenging, potentially reducing anaesthetic and operative risk in certain presentations. Further clinical experience and investigation would be valuable in determining the long-term efficacy and appropriate case selection for this approach in equine practice.
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Practical Takeaways
- •Consider primary hyperparathyroidism in horses presenting with persistently elevated plasma calcium and PTH levels; advanced imaging (3-phase CT and nuclear scintigraphy) can reliably localize abnormal parathyroid tissue
- •Ultrasound-guided ethanol ablation is a viable minimally invasive treatment option that may avoid the morbidity associated with surgical parathyroid resection
- •This technique expands the therapeutic toolkit for managing primary hyperparathyroidism in equine patients, particularly when surgical resection carries higher procedural risk
Key Findings
- •A 15-year-old Miniature Horse with primary hyperparathyroidism was successfully diagnosed using 3-phase computed tomography combined with sestamibi nuclear scintigraphy
- •Percutaneous ultrasound-guided ethanol ablation of abnormal parathyroid tissue resulted in rapid normalization of plasma ionized calcium and serum parathyroid hormone concentrations
- •Chemical ablation represents a novel minimally invasive alternative to surgical resection for treating primary hyperparathyroidism in horses