S. Anna School of Advanced Studies, Department of Internal Medicine, University of Pisa, Italy.
Am J Kidney Dis. 2011 Sep;58(3):485-91. doi: 10.1053/j.ajkd.2011.03.030. Epub 2011 Jun 29.
Secondary hyperparathyroidism (SHPT) is a common complication in patients with chronic kidney disease. In SHPT, the biology of parathyroid cells changes significantly toward diffuse nodular hyperplasia. Currently, diagnosis of SHPT is based on intact parathyroid hormone serum levels and parameters of mineral metabolism. The morphologic diagnosis of SHPT relies on high-resolution ultrasonography with color Doppler imaging. This report describes a maintenance hemodialysis patient with severe SHPT treated using conventional therapy (phosphate binders and oral/intravenous vitamin D or analogues) and the subsequent addition of a calcimimetic. The role of color Doppler ultrasonography in the diagnosis, clinical follow-up, and assessment of therapeutic response of SHPT is discussed. This case suggests that the availability of calcimimetics has changed the natural history of clinical SHPT and may change the therapeutic utility of parathyroidectomy. Use of color Doppler ultrasonography further supports these therapeutic advances, allowing evaluation of the morphologic and vascular changes in hyperplastic parathyroid glands and aiding clinical, pharmacologic, and surgical strategies.
继发性甲状旁腺功能亢进症（SHPT）是慢性肾脏病患者的常见并发症。在 SHPT 中，甲状旁腺细胞的生物学特性发生了显著变化，表现为弥漫性结节性增生。目前，SHPT 的诊断基于全段甲状旁腺激素血清水平和矿物质代谢参数。SHPT 的形态学诊断依赖于高分辨率超声检查联合彩色多普勒成像。本报告描述了一例维持性血液透析患者，该患者患有严重的 SHPT，采用常规治疗（磷结合剂和口服/静脉维生素 D 或类似物），随后加用钙敏感受体激动剂。讨论了彩色多普勒超声在 SHPT 的诊断、临床随访和治疗反应评估中的作用。该病例表明，钙敏感受体激动剂的出现改变了临床 SHPT 的自然病程，可能改变甲状旁腺切除术的治疗效果。彩色多普勒超声的应用进一步支持了这些治疗进展，可评估增生性甲状旁腺的形态和血管变化，并有助于临床、药物和手术策略的制定。
