Paratiroidektomi teknikleri, farmasötik paratiroidektomi ve hipoparatiroidizm
Ther Apher Dial. 2009 Oct;13 Suppl 1:S7-S11.
Cinacalcet in hyperfunctioning parathyroid diseases.
Imanishi Y, Inaba M, Kawata T, Nishizawa Y.
Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City
University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka
545-8585, Japan. imanishi@med.osaka-cu.ac.jp
The calcium-sensing receptor (CaR) on the parathyroid cell surface senses ionized
calcium concentration in the extracellular fluid and regulates minute-to-minute
parathyroid hormone (PTH) secretion. Synthetic allosteric modulators of CaR have
been developed, and one of the positive modulators (calcimimetics) is cinacalcet
HCl or cinacalcet. Cinacalcet increases the sensitivity of CaR to be activated by
extracellular calcium, and thus suppresses PTH release. Cinacalcet is an
effective treatment for secondary hyperparathyroidism (SHPT) in patients with
uremia on hemodialysis. In this review, based on basic experiments using
cinacalcet, we postulate the beneficial effects of cinacalcet on hyperfunctioning
parathyroid diseases.
N Engl J Med. 2008 Jul 24;359(4):391-403.
Clinical practice. Hypoparathyroidism.
Shoback D.
Langenbecks Arch Surg. 2009 Sep;394(5):785-98. Epub 2009 Jun 25.
Surgical strategy for sporadic primary hyperparathyroidism an evidence-based
approach to surgical strategy, patient selection, surgical access, and reoperations.
Mihai R, Barczynski M, Iacobone M, Sitges-Serra A.
John Radcliffe Hospital, Oxford, UK.
PURPOSE: Progress in parathyroid imaging has brought substantial changes in the
surgical strategy to approach patients with sporadic primary hyperparathyroidism
(pHPT). The present review is focused on the safety and efficacy of limited
parathyroid exploration.
MATERIALS AND METHODS: Review of the literature focused on studies dealing with
unilateral (two-gland exploration) or selective parathyroidectomy (one-gland
exploration) in selected patients with pHPT and on the classification of
published reports according to the degree of evidence.
RESULTS: Parathyroid exploration limited to a solitary parathyroid adenoma can be
considered a minimally invasive procedure that can be performed by the minicervicotomy, video-assisted, or endoscopic approaches. In properly selected
patients, it affords results comparable to those of four-gland bilateral
exploration in terms of cure and recurrence. It causes less postoperative
hypocalcemia.
CONCLUSIONS: Selective parathyroidectomy is an option for patients with positive
preoperative localization tests undergoing first-time surgery who have no family
history of pHPT, no goiter for which surgical therapy is proposed, and are not on
lithium therapy.
Langenbecks Arch Surg. 2009 Sep;394(5):799-809. Epub 2009 Jul 10.
Intraoperative adjuncts in surgery for primary hyperparathyroidism.
Harrison BJ, Triponez F.
Endocrine Surgery, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF,
UK. barney.harrison@sth.nhs.uk
PURPOSE: This paper is a review of the evidence base to produce recommendations
for the use of intraoperative parathyroid hormone (PTH), radioguided parathyroidectomy (RGP), methylene blue (MB), frozen section, and intraoperative
neuromonitoring during surgery for primary hyperparathyroidism (PHPT). MATERIALS AND METHODS: A Medline keyword search of English-language articles led
to the production of a draft document, subsequently revised by committee,
containing levels of evidence and the grading of recommendations as proposed by
the Agency for Healthcare Research and Quality.
RESULTS: Literature review provides the basis for clear recommendations on the
use of intraoperative PTH at surgery for PHPT. There is little evidence to
support the use of RGP, MB, routine frozen section, and intraoperative neuromonitoring.
