Marcus R
Department of Gerontology and Endocrinology, Veterans Affairs Medical Center, Palo Alto, California.
J Bone Miner Res. 1991 Oct;6 Suppl 2:S125-9; discussion S151-2. doi: 10.1002/jbmr.5650061426.
One of the common dilemmas in clinical endocrine practice is the management of patients with hyperparathyroidism (HPT) who either cannot or will not undertake definitive surgical treatment. Therapeutic decisions would be simplified by the availability of a nonsurgical approach to control biochemical abnormalities and forestall the consequences of this condition. In the short term, oral phosphorus salts can be safe and effective. For chronic therapy, only estrogens and progestins have been examined in sufficient detail to merit discussion. Estrogens normalize serum and urinary calcium in the majority of older women with HPT. Biochemical control is generally maintained for as long as patients continue treatment. The data support the view that estrogen inhibits the actions of PTH, particularly on bone, but does not reduce the abnormal PTH secretion. Androgenic progestins may also lower serum and urinary calcium in HPT, but current data suggest that normalization of serum calcium levels is more likely to occur with estrogen. Although reduction in urinary calcium excretion should prove effective in preventing nephrolithiasis, it is unclear whether hormone therapy provides protection against fracture. Whether or not hormone replacement is prescribed, nonsurgical management requires a highly committed patient who is willing to undergo extensive and prolonged follow-up.
临床内分泌实践中常见的难题之一是对那些无法或不愿接受确定性手术治疗的甲状旁腺功能亢进症（HPT）患者的管理。如果有一种非手术方法可以控制生化异常并预防这种疾病的后果，治疗决策将会简化。短期内，口服磷盐可能既安全又有效。对于长期治疗，只有雌激素和孕激素经过了足够详细的研究，值得讨论。雌激素可使大多数老年HPT女性的血清和尿钙恢复正常。只要患者持续治疗，生化指标通常就能得到维持。数据支持这样的观点，即雌激素会抑制甲状旁腺激素（PTH）的作用，尤其是对骨骼的作用，但不会减少异常的PTH分泌。雄激素类孕激素也可能降低HPT患者的血清和尿钙，但目前的数据表明，雌激素更有可能使血清钙水平恢复正常。虽然减少尿钙排泄应该能有效预防肾结石，但激素疗法是否能预防骨折尚不清楚。无论是否开了激素替代疗法，非手术管理都需要一位非常坚定的患者，愿意接受广泛且长期的随访。
