Division of Nephrology and Hypertension, Medical Department, Klinikum Coburg III, D-96450 Coburg, Germany.
Int J Endocrinol. 2011;2011:415719. doi: 10.1155/2011/415719. Epub 2011 Mar 6.
Although parathyroidectomy remains the only curative approach to most primary hyperparathyroidism cases, medical treatment with cinacalcet HCl has been proven to be a reasonable alternative for several patient subgroups. Cinacalcet almost always controls hypercalcemia and hypophosphatemia sufficiently. PTH levels are lowered, and cognitive parameters improve. While an increase in bone mineral density DEXA scan scores was not demonstrated in cinacalcet trials, the same applies to more than half of patients after parathyroidectomy. Medical therapy should be first choice in patients with hyperplasia in all glands rather than an isolated adenoma (10-15%), patients with persisting HPT following unsuccessful surgery or inoperable cases due to comorbidities, and patients detected in lab screens for hypercalcemia before developing symptoms who should be treated early but are usually reluctant to undergo surgery. Nephrolithiasis was not found to occur more frequently in cinacalcet trial groups, but urine calcium excretion as one major risk factor of this complication of primary HPT may increase on cinacalcet. Patients carrying the rs1042636 polymorphism of the calcium-sensing receptor gene respond more sensitively to cinacalcet and have a higher risk of calcium stone formation. Cinacalcet is usually administered twice daily but three or four doses per day should be discussed to mimic the beneficial pulsatile PTH-pattern.
虽然甲状旁腺切除术仍然是大多数原发性甲状旁腺功能亢进症病例的唯一治愈方法，但盐酸西那卡塞的药物治疗已被证明是几个患者亚组的合理替代方法。西那卡塞几乎总能充分控制高钙血症和低磷血症。甲状旁腺激素水平降低，认知参数改善。虽然在西那卡塞试验中并未显示骨密度 DEXA 扫描评分增加，但在甲状旁腺切除术后的一半以上患者中也同样如此。对于所有腺体增生而不是孤立腺瘤（10-15%）的患者、手术不成功或因合并症而无法手术的患者以及在出现症状之前因高钙血症而在实验室筛查中发现的患者，应首先选择药物治疗，这些患者应早期治疗，但通常不愿意接受手术。在西那卡塞试验组中未发现肾结石的发生频率更高，但作为原发性 HPT 这种并发症的主要危险因素之一的尿钙排泄可能会在西那卡塞治疗后增加。携带钙敏感受体基因 rs1042636 多态性的患者对西那卡塞更敏感，且钙结石形成的风险更高。西那卡塞通常每天给药两次，但应讨论每天三或四次剂量以模拟有益的脉冲式甲状旁腺激素模式。
