Endocrine Unit, Evgenidion Hospital, University of Athens, 20 Papadiamantopoulou Str, 11528, Athens, Greece.
Endocrine. 2011 Jun;39(3):199-204. doi: 10.1007/s12020-011-9452-7. Epub 2011 Mar 26.
Primary hyperparathyroidism (pHPT), which most frequently occurs asymptomatically, is a common endocrine disease associated with increased morbidity and mortality. The newly introduced management guidelines as well as the recent availability of the first calcimimetic offer a highly promising therapeutic option for patients with pHPT. Cinacalcet, the first available calcimimetic, increases the sensitivity of the calcium-sensing receptor (CaR) to circulating serum calcium, thereby safely reducing serum calcium and PTH concentrations in patients with mild-to-moderate pHPT, intractable disease, and also parathyroid carcinoma. Cinacalcet has proved efficient in short- and long-term controls of hypercalcemia and, though bone mineral density was not improved, the available data point to cinacalcet as the treatment of choice in non-operable patients with pHPT. These results encompass a wide spectrum of disease severity. Results are pending as to whether cinacalcet decreases mortality and morbidity in pHPT, confirmation of which would conclusively recommend this drug as a valid alternative to surgery.
原发性甲状旁腺功能亢进症（pHPT）常无症状发生，是一种常见的内分泌疾病，与发病率和死亡率增加有关。新出台的管理指南以及最近出现的第一种拟钙剂为 pHPT 患者提供了一种极具前景的治疗选择。西那卡塞是第一种可用的拟钙剂，它增加了钙敏感受体（CaR）对循环血清钙的敏感性，从而安全地降低了轻度至中度 pHPT、难治性疾病和甲状旁腺癌患者的血清钙和 PTH 浓度。西那卡塞已被证明在短期和长期控制高钙血症方面有效，尽管骨密度没有改善，但现有数据表明，西那卡塞是 pHPT 非手术患者的首选治疗药物。这些结果涵盖了广泛的疾病严重程度。西那卡塞是否能降低 pHPT 患者的死亡率和发病率仍有待观察，若能证实，将明确推荐该药物作为手术的有效替代方案。
