Parathyroid adenoma medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2]
Overview
Medical Therapy
Medical therapy for hyperparathyroidism due to parathyroid adenoma should be considered in the following circumstances:[1]
- Patients with hyperparathyroidism not meeting the guidelines for surgery.
- Patients with hyperparathyroidism having contraindications to surgery.
- Patient with hyperparathyroidism who have previous unsuccessful neck exploration.
- Patient with hyperparathyroidism who have not been cured by surgery.
- Patient with hyperparathyroidism refuses surgery.
Medical Management
- 1. Primary hyperparathyroidism
- 1.1 Nutritional supplementation[2]
- 1.1.1 Low calcium intake[3]
- Preferred regimen (1): Elemental calcium 500 mg PO q24h
- Note: Dietary calcium restriction is not necessary in primary hyperparathyroidism.
- 1.1.2 Vitamin D depletion
- Preferred regimen (1): Cholecalciferol 600–1000 IU PO q24h
- Note(1): Vitamin D deficiency is considered when serum level of 25-hydroxy vitamin D is below 50 nM (20 ng/mL).[4]
- Note(2): Serum calcium levels and urinary calcium excretion should be monitored during vitamin D supplementation. Vitamin D supplementation should be stopped if serum calcium levels is >11.6 mg/dL and/or urinary calcium excretion is >400 mg/24 h.
- Note(3): The goal of vitamin D supplementation is to keep 25-hydroxy vitamin D level between 50 nmol/L to 75 nmol/L.
- 1.1.1 Low calcium intake[3]
- 1.2 Pharmacotherapy
- 1.2.1 Bisphosphonates
- Preferred regimen (1): Alendronate 10 mg PO q24h[5][6]
- 1.2.2 Calcimimetics
- Preferred regimen (1): Cinacalcet HCl 30-120 mg PO q12h[7][8]
- Note(1): Cinacalcet may be used in patients with familial primary hyperparathyroidism as a treatment option for patients having recurrent or persistent hypercalcemia after parathyroidectomy.
- Note(2): A combination of bisphosphonates and calcimimetics may be used to reduce the serum calcium and improve bone mineral density.[9]
- 1.2.3 Estrogen receptor-targeted therapy (post-menopausal women)
- Preferred regimen (1): Conjugated equine estrogen 0.625 mg q24h + medroxyprogesterone acetate 5mg q24h
- Note(1): The risk-benefit ratio should be assessed with respect to known relative or absolute contraindication to use of estrogen in each patient.
- 1.2.1 Bisphosphonates
- 1.1 Nutritional supplementation[2]
References
- ↑ Khan AA (2013). "Medical management of primary hyperparathyroidism". J Clin Densitom. 16 (1): 60–3. doi:10.1016/j.jocd.2012.11.010. PMID 23374743.
- ↑ Marcocci C, Bollerslev J, Khan AA, Shoback DM (2014). "Medical management of primary hyperparathyroidism: proceedings of the fourth International Workshop on the Management of Asymptomatic Primary Hyperparathyroidism". J Clin Endocrinol Metab. 99 (10): 3607–18. doi:10.1210/jc.2014-1417. PMID 25162668.
- ↑ Jorde R, Szumlas K, Haug E, Sundsfjord J (2002). "The effects of calcium supplementation to patients with primary hyperparathyroidism and a low calcium intake". Eur J Nutr. 41 (6): 258–63. doi:10.1007/s00394-002-0383-1. PMID 12474069.
- ↑ Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK; et al. (2011). "The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know". J Clin Endocrinol Metab. 96 (1): 53–8. doi:10.1210/jc.2010-2704. PMC 3046611. PMID 21118827.
- ↑ Chow CC, Chan WB, Li JK, Chan NN, Chan MH, Ko GT; et al. (2003). "Oral alendronate increases bone mineral density in postmenopausal women with primary hyperparathyroidism". J Clin Endocrinol Metab. 88 (2): 581–7. doi:10.1210/jc.2002-020890. PMID 12574184.
- ↑ Khan AA, Bilezikian JP, Kung AW, Ahmed MM, Dubois SJ, Ho AY; et al. (2004). "Alendronate in primary hyperparathyroidism: a double-blind, randomized, placebo-controlled trial". J Clin Endocrinol Metab. 89 (7): 3319–25. doi:10.1210/jc.2003-030908. PMID 15240609.
- ↑ Peacock M, Bilezikian JP, Klassen PS, Guo MD, Turner SA, Shoback D (2005). "Cinacalcet hydrochloride maintains long-term normocalcemia in patients with primary hyperparathyroidism". J Clin Endocrinol Metab. 90 (1): 135–41. doi:10.1210/jc.2004-0842. PMID 15522938.
- ↑ Luque-Fernández I, García-Martín A, Luque-Pazos A (2013). "Experience with cinacalcet in primary hyperparathyroidism: results after 1 year of treatment". Ther Adv Endocrinol Metab. 4 (3): 77–81. doi:10.1177/2042018813482344. PMC 3666442. PMID 23730501.
- ↑ Faggiano A, Di Somma C, Ramundo V, Severino R, Vuolo L, Coppola A; et al. (2011). "Cinacalcet hydrochloride in combination with alendronate normalizes hypercalcemia and improves bone mineral density in patients with primary hyperparathyroidism". Endocrine. 39 (3): 283–7. doi:10.1007/s12020-011-9459-0. PMID 21445714.