Srivastava Tarak, Jafri Shahryar, Truog William E, Sebestyen VanSickle Judith, Manimtim Winston M, Alon Uri S
Sections of Nephrology, Bone and Mineral Disorder Clinic, and.
Neonatology, The Children's Mercy Hospitals and Clinics, University of Missouri at Kansas City, Kansas City, Missouri.
Pediatrics. 2017 Dec;140(6). doi: 10.1542/peds.2016-3789.
Secondary hyperparathyroidism (SHPT) is a rare complication of furosemide therapy that can occur in patients treated with the loop diuretic for a long period of time. We report a 6-month-old 28-weeks premature infant treated chronically with furosemide for his bronchopulmonary dysplasia, who developed hypocalcemia and severe SHPT, adversely affecting his bones. Discontinuation of the loop diuretic and the addition of supplemental calcium and calcitriol only partially reversed the SHPT, bringing serum parathyroid hormone level down from 553 to 238 pg/mL. After introduction of the calcimimetic Cinacalcet, we observed a sustained normalization of parathyroid hormone concentration at 27 to 63 pg/mL and, with that correction, of all biochemical abnormalities and healing of the bone disease. No adverse effects were noted. We conclude that in cases of SHPT due to furosemide in which traditional treatment fails, there may be room to consider the addition of a calcimimetic agent.
继发性甲状旁腺功能亢进（SHPT）是速尿治疗的一种罕见并发症，可发生于长期使用袢利尿剂治疗的患者。我们报告了一名6个月大、28周早产的婴儿，因支气管肺发育不良长期接受速尿治疗，出现了低钙血症和严重的SHPT，对其骨骼产生了不利影响。停用袢利尿剂并补充钙和骨化三醇仅部分逆转了SHPT，使血清甲状旁腺激素水平从553降至238 pg/mL。引入拟钙剂西那卡塞后，我们观察到甲状旁腺激素浓度持续正常化至27至63 pg/mL，随着这种纠正，所有生化异常均得到改善，骨病也得以治愈。未观察到不良反应。我们得出结论，在因速尿导致的SHPT病例中，若传统治疗失败，可能有考虑添加拟钙剂的空间。
