Jacobs L, Samson M M, Verhaar H J J, Koek H L
Department of Internal Medicine, St Antonius Hospital Nieuwegein, Nieuwegein, the Netherlands.
Neth J Med. 2012 Jan;70(1):35-8.
Hypercalcaemia resulting from primary hyperparathyroidism (PHPT) can cause a wide range of symptoms, including cognitive disorders, psychiatric symptoms and muscle weakness. Parathyroid surgery is the only definite cure for PHPT. When surgery is contraindicated or patients decide against it, several non-surgical treatment options are available.
To illustrate the treatment options of symptomatic hypercalcaemia caused by PHPT in the elderly and discuss these options in consideration of the available evidence.
Consecutive case series.
University hospital.
Four older patients aged 79-87 years with symptomatic hypercalcaemia resulting from PHPT.
Three patients had a parathyroid adenoma shown on a sestamibi scan. Normocalcaemia and resolution of symptoms was achieved by different treatment scenarios encompassing forced saline hydration, forced diuresis, intravenous pamidronate and cinacalcet, a calcimimetic drug. In one patient, no parathyroid abnormalities were revealed with imaging. Treatment with cinacalcet resulted in normocalcaemia and a strong improvement of symptoms.
In clinical practice, different treatment scenarios are chosen for the treatment of elderly patients with symptomatic hypercalcaemia caused by PHPT. The introduction of cinacalcet offers a new treatment paradigm. We propose to apply cinacalcet preceding elective surgery as an alternative option to standard therapy or as maintenance dose when surgery is not possible.
原发性甲状旁腺功能亢进症（PHPT）导致的高钙血症可引起广泛症状，包括认知障碍、精神症状和肌肉无力。甲状旁腺手术是治疗PHPT的唯一确切方法。当手术禁忌或患者拒绝手术时，有几种非手术治疗选择。
阐述老年PHPT所致症状性高钙血症的治疗选择，并根据现有证据对这些选择进行讨论。
连续病例系列。
大学医院。
4例年龄在79 - 87岁的老年患者，因PHPT出现症状性高钙血症。
3例患者的甲氧基异丁基异腈扫描显示有甲状旁腺腺瘤。通过包括强制生理盐水水化、强制利尿、静脉注射帕米膦酸盐和西那卡塞（一种拟钙剂）在内的不同治疗方案，实现了血钙正常和症状缓解。1例患者影像学检查未发现甲状旁腺异常。西那卡塞治疗使血钙正常，症状明显改善。
在临床实践中，对于老年PHPT所致症状性高钙血症患者，会选择不同的治疗方案。西那卡塞的引入提供了一种新的治疗模式。我们建议在择期手术前应用西那卡塞，作为标准治疗的替代选择或在无法进行手术时作为维持剂量。
