Mampel E, Koall W, Hintner I
Z Gesamte Inn Med. 1977 Apr 1;32(7):103-5.
The development of an autonomous (tertiary) hyperparathyroidism in patients with renal diseases must clinically be taken into consideration, when by therapeutic measures the causes of a compensatory overfunction of the parathyroid glands were excluded, but the symptoms of a hyperparathyroidism continue or even increase. This is of special importance in the control of patients with renal grafts. The increase of the serum calcium on more than the normal value in simultaneously increased serum phosphate level and increased activity of the alkaline bone phosphatase in connection with demineralisation of the skeleton, osteoclastic changes of the bones and estraossary calcifications may be regarded as early symptoms of a hyperparathyroidism. It is to be discussed the hypothesis, whether in every autonomous hyperparathyroidism a regulative reaction precedes. In patients with renal diseases in a limited number a prevention of the regulative overfunction of the parathyroid glands is possible by an early compensation of a calcium deficit (acquired vitamin D resistance), a hyperphosphataemia and a renal acidosis.
当通过治疗措施排除了甲状旁腺代偿性功能亢进的原因，但甲状旁腺功能亢进的症状仍持续甚至加重时，临床上必须考虑肾病患者发生自主性（继发性）甲状旁腺功能亢进的情况。这在肾移植患者的管理中尤为重要。血清钙升高超过正常值，同时血清磷水平升高、碱性骨磷酸酶活性增加，伴有骨骼脱矿质、骨的破骨细胞改变和骨外钙化，可被视为甲状旁腺功能亢进的早期症状。需要讨论这样一个假说，即是否在每一例自主性甲状旁腺功能亢进之前都有一个调节反应。在少数肾病患者中，通过早期纠正钙缺乏（获得性维生素D抵抗）、高磷血症和肾性酸中毒，有可能预防甲状旁腺的调节性功能亢进。
