Okada Manabu, Tominaga Yoshihiro, Izumi Kumiko, Nobata Hironobu, Yamamoto Takayuki, Hiramitsu Takahisa, Tsujita Makoto, Goto Norihiko, Nanmoku Koji, Watarai Toshihiko, Uchida Kazuharu
Department of Transplantation and Endocrine Surgery, Nagoya Second Red Cross Hospital, Showa-ku, Nagoya, Japan.
Ther Apher Dial. 2011 Jun;15 Suppl 1:33-7. doi: 10.1111/j.1744-9987.2011.00924.x.
Cinacalcet hydrochloride (cinacalcet) has been reported to be efficacious for patients with tertiary hyperparathyroidism (THPT). We experienced five patients with THPT requiring parathyroidectomy (PTx) because of resistance to cinacalcet treatment and investigated their clinical characteristics and clinical course. The maximum diameter of the parathyroid gland estimated by ultrasonography before renal transplantation was evaluated. Serum total calcium, phosphorus, intact parathyroid hormone (iPTH), alkaline phosphatase (ALP), and creatinine (Cr) levels were investigated every three months after the administration of cinacalcet and at PTx. After surgery, the Cr levels were followed. In all five patients, at least one parathyroid gland had a largest diameter of more than 1 cm, and the mean diameter was 18.7 mm (range 14.9-24.1 mm). Intact PTH and ALP levels gradually increased after the initiation of cinacalcet and the Cr levels transiently increased after PTx. These findings suggest that the existence of a severely enlarged nodular hyperplastic gland is a main factor involved in resistance to cinacalcet.
据报道，盐酸西那卡塞（西那卡塞）对三发性甲状旁腺功能亢进症（THPT）患者有效。我们遇到了5例因对西那卡塞治疗耐药而需要进行甲状旁腺切除术（PTx）的THPT患者，并对他们的临床特征和临床病程进行了调查。评估了肾移植前通过超声检查估计的甲状旁腺最大直径。在给予西那卡塞后每三个月以及在PTx时，对血清总钙、磷、完整甲状旁腺激素（iPTH）、碱性磷酸酶（ALP）和肌酐（Cr）水平进行调查。手术后，对Cr水平进行跟踪。在所有5例患者中，至少有一个甲状旁腺的最大直径超过1 cm，平均直径为18.7 mm（范围为14.9 - 24.1 mm）。开始使用西那卡塞后，iPTH和ALP水平逐渐升高，PTx后Cr水平短暂升高。这些发现表明，存在严重肿大的结节性增生性腺是导致对西那卡塞耐药的主要因素。
