Title:Pathophysiology and Treatment of Nonfamilial Hyperparathyroidism
Volume: 9
Issue: 3
Author(s): Franco Lumachi and Stefano M.M. Basso
Affiliation:
Keywords:
Calcium metabolism, hyperparathyroidism, parathyroid hormone, parathyroidectomy, parathyroid glands, primary
hyperparathyroidism, PTH, secondary hyperparathyroidism.
Abstract: Primary hyperparathyroidism (HPT) is the main cause of hypercalcemia and the most common parathyroid
glands disease. The diagnosis is easy in patients with hypercalcemia and elevated PTH serum level. Minimally invasive
parathyroidectomy (PTx) represents the treatment of choice for symptomatic patients, leading to several advantages, including
immediate normalization of hypercalcemia and significant improvement of bone mineral density, cardiovascular
dysfunctions, neuropsychological symptoms and quality of life. Secondary and tertiary HPT are relatively common complications
in patients with chronic kidney disease (CKD) or advanced kidney failure, and in kidney transplant recipients
who did not achieve complete calcium/phosphate metabolism normalization, respectively. The drugs available for patients
with secondary HPT, and to treat hyperphosphatemia include non-calcium-containing phosphate binder, calcitriol analogues,
calcimimetic agents, or a combination of two or more drugs. Although recent studies report that PTx significantly
improves survival also in patients with CKD and severe secondary HPT, the indications for surgery are not yet well established.
Subtotal or total PTx with or without autotransplantation are the surgical options for treating all patients with secondary
HPT. Total PTx leads to a faster reduction in serum calcium level and normalization of PTH, but the risk of hypoparathyroidism
is higher than after subtotal PTx. Further studies are needed to confirm the usefulness of the drugs currently
recommended, and others will have to be tested in the near future.
