Rodríguez-Ortiz María E, Rodríguez Mariano
Maimónides Institute for Biomedical Research (IMIBIC), Avda. Menéndez Pidal, S/N. 14004 Córdoba, Spain.
University of Córdoba, Avda. Medina Azahara, 5. 14071 Córdoba, Spain.
F1000Res. 2020 Sep 1;9. doi: 10.12688/f1000research.22636.1. eCollection 2020.
Secondary hyperparathyroidism is a complex pathology that develops as chronic kidney disease progresses. The retention of phosphorus and the reductions in calcium and vitamin D levels stimulate the synthesis and secretion of parathyroid hormone as well as the proliferation rate of parathyroid cells. Parathyroid growth is initially diffuse but it becomes nodular as the disease progresses, making the gland less susceptible to be inhibited. Although the mechanisms underlying the pathophysiology of secondary hyperparathyroidism are well known, new evidence has shed light on unknown aspects of the deregulation of parathyroid function. Secondary hyperparathyroidism is an important feature of chronic kidney disease-mineral and bone disorder and plays an important role in the development of bone disease and vascular calcification. Thus, part of the management of chronic kidney disease relies on maintaining acceptable levels of mineral metabolism parameters in an attempt to slow down or prevent the development of secondary hyperparathyroidism. Here, we will also review the latest evidence regarding several aspects of the clinical and surgical management of secondary hyperparathyroidism.
继发性甲状旁腺功能亢进是一种随着慢性肾脏病进展而出现的复杂病理状态。磷的潴留以及钙和维生素D水平的降低会刺激甲状旁腺激素的合成与分泌，以及甲状旁腺细胞的增殖速率。甲状旁腺增生起初是弥漫性的，但随着疾病进展会形成结节，使得腺体对抑制作用的敏感性降低。尽管继发性甲状旁腺功能亢进的病理生理机制已为人熟知，但新的证据揭示了甲状旁腺功能失调未知的方面。继发性甲状旁腺功能亢进是慢性肾脏病 - 矿物质和骨异常的一个重要特征，在骨病和血管钙化的发生发展中起重要作用。因此，慢性肾脏病的部分治疗依赖于维持矿物质代谢参数在可接受水平，以试图减缓或预防继发性甲状旁腺功能亢进的发展。在此，我们还将综述有关继发性甲状旁腺功能亢进临床和外科治疗几个方面的最新证据。
