Bichler K H, Strohmaier W L, Mittermüller B
Abteilung für Urologie, Eberhard-Karls-Universität Tübingen.
Urologe A. 1996 Sep;35(5):408-12. doi: 10.1007/s001200050042.
The different subgroups of hypercalciuria cannot be separated clearly by the Pak calcium-load test. To improve the diagnosis and therapy we examined all relevant parameters of calcium metabolism in 32 patients with calcium urolithiasis and hypercalciuria (> 6.25 mmol/day). We also conducted bone mineral density measurements as well as the Pak calcium-load test. In most cases the pathophysiological constellations which Pak takes as the basis for his classification of hypercalciuria could not be shown. To date, diagnostics only insufficiently explains the genesis of hypercalciuria (except pHPT). As a consequence, a therapeutic problem arises: a low-calcium diet should not be generally recommended, since some patients may develop osteopenia. From our investigation the following diagnostic and therapeutic conclusions can be drawn: (1) Hypercalciuria in primary hyperparathyroidism should be treated by surgical removal of the adenoma. (2) The parathormone-independent osteogenic form should be treated with thiazides. (3) Hypercalciuria with increased 1.25-dihydroxyvitamin D should be treated by low-calcium diet.
高钙尿症的不同亚组无法通过帕克钙负荷试验清楚地区分开来。为了改善诊断和治疗，我们检查了32例钙结石病和高钙尿症（>6.25 mmol/天）患者钙代谢的所有相关参数。我们还进行了骨密度测量以及帕克钙负荷试验。在大多数情况下，帕克作为其高钙尿症分类基础的病理生理情况无法得到证实。迄今为止，诊断仅不足以解释高钙尿症的成因（除了原发性甲状旁腺功能亢进症）。因此，出现了一个治疗问题：一般不应推荐低钙饮食，因为一些患者可能会出现骨质减少。从我们的研究中可以得出以下诊断和治疗结论：（1）原发性甲状旁腺功能亢进症中的高钙尿症应通过手术切除腺瘤进行治疗。（2）不依赖甲状旁腺激素的成骨型应使用噻嗪类药物治疗。（3）1,25 - 二羟维生素D升高的高钙尿症应采用低钙饮食治疗。
