Kakuta Takatoshi, Sawada Kaichiro
Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan.
Clin Calcium. 2014 Dec;24(12):1801-8.
Parathyroid monitors the calcium concentration in blood by signals from calcium-sensing receptors, adjusts secretion of parathyroid hormone to keep constant calcium concentration in the body. Although parathyroid parenchymal cells consist of chief cells which secrete PTH, and oxyphil cells which are rich in mitochondria, all hardly perform mitotic proliferation in normal status. However, in CKD, PTH hypersecretion and hyperplasia are started by hyperphosphatemia, hypocalcemia, and activated-vitamin-D deficiency, and the secondary hyperparathyroidism develops. While treatment with cinacalcet hydrochloride salt induced apoptosis into the parathyroid cell, a possibility of promoting the transdifferentiation to oxyphil cells from chief cells was suggested. The specific accumulation to the parathyroid of an oncotropic photosensitizer suggests the possibility of photodynamic diagnosis and treatment of hyperparathyroidism.
甲状旁腺通过钙敏感受体发出的信号监测血液中的钙浓度，调节甲状旁腺激素的分泌以维持体内钙浓度恒定。尽管甲状旁腺实质细胞由分泌甲状旁腺激素的主细胞和富含线粒体的嗜酸性细胞组成，但在正常状态下它们几乎都不进行有丝分裂增殖。然而，在慢性肾脏病中，高磷血症、低钙血症和活性维生素D缺乏会引发甲状旁腺激素分泌过多和增生，继而发展为继发性甲状旁腺功能亢进。虽然盐酸西那卡塞治疗可诱导甲状旁腺细胞凋亡，但也有人提出存在主细胞向嗜酸性细胞转分化增强的可能性。亲肿瘤性光敏剂在甲状旁腺中的特异性蓄积提示了光动力诊断和治疗甲状旁腺功能亢进的可能性。
