Zhang Peiheng, Yu Yang, Gao Ying, Yuan Geheng, Zhang Junqing, Wang Wei
Department of Endocrinology, Peking University First Hospital, Beijing, China.
Hemodial Int. 2023 Apr;27(2):E23-E28. doi: 10.1111/hdi.13063. Epub 2023 Jan 31.
The most appropriate surgical procedure for tertiary hyperparathyroidism is still controversial. Medical management may be considered in those patients with failed previous surgical intervention. There are limited medical options for tertiary hyperparathyroidism with renal dysfunction. The monoclonal antibody denosumab has been used in patients with osteoporosis and hypercalcemia of malignancy. We report a case of medically refractory hypercalcemia caused by tertiary hyperparathyroidism treated with denosumab. A 46-year-old female was on hemodialysis for 10 years. She was diagnosed with tertiary hyperparathyroidism due to hypercalcemia with a high level of intact parathyroid hormone (iPTH, 1411 pg/ml). After right parathyroidectomy 6 weeks, her serum calcium remained persistently elevated (Ca, 3.17 mmoL/L). Denosumab (60 mg) was administered subcutaneously, and her serum calcium quickly decreased (from 3.43 to 2.04 mmoL/L within 8 days) and was slightly elevated (Ca, 2.8 mmoL/L) 3 months later. We conclude that denosumab has a significant effect on the reduction of serum calcium for tertiary hyperparathyroidism patients. The long-term treatment effect and safety warrant more studies in the future.
对于三发性甲状旁腺功能亢进症，最合适的外科手术方法仍存在争议。对于既往手术干预失败的患者，可以考虑药物治疗。对于伴有肾功能不全的三发性甲状旁腺功能亢进症，药物选择有限。单克隆抗体地诺单抗已用于治疗骨质疏松症和恶性肿瘤引起的高钙血症患者。我们报告了1例用地诺单抗治疗三发性甲状旁腺功能亢进症所致药物难治性高钙血症的病例。一名46岁女性接受血液透析10年。她因高钙血症伴甲状旁腺激素（iPTH，1411 pg/ml）水平升高而被诊断为三发性甲状旁腺功能亢进症。右侧甲状旁腺切除术后6周，她的血清钙持续升高（Ca，3.17 mmol/L）。皮下注射地诺单抗（60 mg）后，她的血清钙迅速下降（8天内从3.43降至2.04 mmol/L），3个月后略有升高（Ca，2.8 mmol/L）。我们得出结论，地诺单抗对降低三发性甲状旁腺功能亢进症患者的血清钙有显著效果。其长期治疗效果和安全性值得未来开展更多研究。
