Lo Cascio V, Rossini M, Bertoldo F
Clinica di Medicina Interna D, Università, Verona.
Recenti Prog Med. 1993 Apr;84(4):287-95.
The first-choice treatment of primary hyperparathyroidism is surgical removal of abnormal parathyroid gland(s) and the medical management is usually reserved only to control severe hypercalcemia. However, asymptomatic primary hyperparathyroidism with mild hypercalcemia and renal and bone status close to normal is now the more common picture of the disease and in this situation conservative management can be considered, because many of those patients may have a prolonged benign course. Management guidelines are therefore devised to minimize the risk for deterioration of renal, skeletal or gastrointestinal complications of hyperparathyroidism. General medical management includes recommendation to avoid dehydration, immobilization or excessive dietary calcium intake and therapy with thiazides; intravenous infusion with isotonic saline combined to furosemide or etacrinic acid are recommended to treat acute or threatening hypercalcemia. Many other drugs as phosphate, mithramycin, gallium nitrate and calcitonin have been reported to be useful in reversing hypercalcemia but their transient effects, toxicity and side effects limit their clinical use. The bisphosphonates, a new class of bone resorption inhibitors, have been shown to be particularly safe so they result especially effective on controlling acute hypercalcemia and on preventing "hungry bone" disease. However, their effect is not sustained because the serum calcium tends to return toward pretreatment levels despite continued therapy; therefore their consistent beneficial effect on long-term treatment seems unlike.
原发性甲状旁腺功能亢进的首选治疗方法是手术切除异常甲状旁腺，药物治疗通常仅用于控制严重的高钙血症。然而，无症状的原发性甲状旁腺功能亢进伴轻度高钙血症且肾脏和骨骼状况接近正常，如今是该疾病更常见的表现，在这种情况下可考虑保守治疗，因为许多此类患者可能病程呈良性且持续时间较长。因此制定了管理指南，以尽量降低甲状旁腺功能亢进导致肾脏、骨骼或胃肠道并发症恶化的风险。一般药物治疗包括建议避免脱水、制动或过量摄入膳食钙以及噻嗪类药物治疗；推荐静脉输注等渗盐水并联合使用呋塞米或依他尼酸来治疗急性或有威胁的高钙血症。据报道，许多其他药物如磷酸盐、光辉霉素、硝酸镓和降钙素在逆转高钙血症方面有用，但它们的短暂作用、毒性和副作用限制了其临床应用。双膦酸盐是一类新型的骨吸收抑制剂，已被证明特别安全，因此它们在控制急性高钙血症和预防“饥饿骨”病方面尤其有效。然而，它们的效果并不持久，因为尽管持续治疗，血清钙仍倾向于恢复到治疗前水平；因此它们对长期治疗的持续有益作用似乎并不明显。
