Eremkina Anna, Krupinova Julia, Dobreva Ekaterina, Gorbacheva Anna, Bibik Ekaterina, Samsonova Margarita, Ajnetdinova Alina, Mokrysheva Natalya
Endocrinology Research Center, Russian Federation, Moscow, Russia.
Faculty of Fundamental Medicine, ederal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University, Moscow, Russia.
Endocr Connect. 2020 Oct;9(10):1019-1027. doi: 10.1530/EC-20-0380.
Hypercalcemic crisis is a severe but rare complication of primary hyperparathyroidism (PHPT), and data on denosumab treatment of patients with this disease is still very limited. The aim of this paper is to investigate the hypocalcemic effect of denosumab in PHPT patients with severe hypercalcemia when surgery should be delayed or is impossible for some reasons. We performed a retrospective study of 10 patients. The analysis included the use of biochemical markers of calcium-phosphorus metabolism, which were followed after the administration of 60 mg of denosumab. The trend to calcium reduction was already determined on the 3rd day after denosumab administration. In most cases the decrease in serum calcium level to the range of 2.8 mmol/L on average or lower was observed on the 7th day (P = 0.002). In addition to a significant increase in calcium levels we confirmed a significant increase in the estimated glomerular filtration rate on 7th day (P = 0.012). After that, seven patients underwent successful parathyroidectomy and achieved eucalcemia or hypocalcemia, one patient developed the recurrence of parathyroid cancer after initial surgery, while two patients with severe cardiovascular pathology refused surgery. Our study shows that denosumab is a useful tool in PHPT-associated hypercalcemia before surgery or if surgery is contraindicated.
高钙血症危象是原发性甲状旁腺功能亢进症（PHPT）的一种严重但罕见的并发症，关于地诺单抗治疗该疾病患者的数据仍然非常有限。本文的目的是研究在因某些原因手术应推迟或无法进行时，地诺单抗对PHPT伴严重高钙血症患者的降钙作用。我们对10例患者进行了回顾性研究。分析包括使用钙磷代谢的生化标志物，在给予60mg地诺单抗后对其进行跟踪监测。地诺单抗给药后第3天就已确定有钙降低的趋势。在大多数情况下，第7天观察到血清钙水平平均降至2.8mmol/L或更低范围（P = 0.002）。除了钙水平显著升高外，我们还证实第7天估计肾小球滤过率显著升高（P = 0.012）。此后，7例患者成功进行了甲状旁腺切除术并实现了血钙正常或低钙血症，1例患者在初次手术后发生甲状旁腺癌复发，而2例患有严重心血管疾病的患者拒绝手术。我们的研究表明，地诺单抗在手术前或手术禁忌时是治疗PHPT相关高钙血症的有用工具。
