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Current medical management of secondary hyperparathyroidism.

Abstract
The treatment of secondary hyperparathyroidism (HPT) in patients with chronic renal disease has improved markedly in recent years. The skeletal pain, disabling fractures, tendon ruptures, and myriad other symptoms associated with HPT can now be avoided, and the quality of life of patients with end-stage renal disease is improved. Control of hyperphosphatemia, maintenance of normocalcemia, and appropriate dosing of vitamin D analogues can prevent HPT in many cases. Palatable, nutritious diets should be followed; serum calcium, phosphorus, alkaline phosphatase, and parathyroid hormone should be monitored; and treatment regimens should be adjusted accordingly. If prevention fails, and even if severe HPT develops, many of these patients can still be controlled medically with correction of hyperphosphatemia and high doses of intravenous calcitriol. In our experience, only a few patients require surgical parathyroidectomy (usually noncompliant patients or patients whose HPT has been poorly managed from early uremia). The essence to medical management is to correct the two most important pathogenetic factors of HPT, hyperphosphatemia, and calcitriol deficiency. We present the current approach to the management of HPT, with highlights of recent advances.
AuthorsM Yudd, F Llach
JournalThe American journal of the medical sciences (Am J Med Sci) Vol. 320 Issue 2 Pg. 100-6 (Aug 2000) ISSN: 0002-9629 [Print] United States
PMID10981484 (Publication Type: Journal Article, Review)
Chemical References
  • Acetates
  • Calcium Compounds
  • Magnesium Compounds
  • Parathyroid Hormone
  • Phosphates
  • Phosphorus, Dietary
  • Ethanol
  • Calcitriol
  • Calcium Carbonate
  • Calcium
  • calcium acetate
Topics
  • Acetates (pharmacology)
  • Administration, Oral
  • Calcitriol (administration & dosage)
  • Calcium (blood)
  • Calcium Carbonate (pharmacology)
  • Calcium Compounds
  • Ethanol (administration & dosage)
  • Humans
  • Hyperparathyroidism, Secondary (blood, complications, therapy)
  • Injections, Intravenous
  • Intestinal Absorption (drug effects)
  • Kidney Failure, Chronic (complications)
  • Magnesium Compounds (pharmacology)
  • Parathyroid Hormone (blood)
  • Parathyroidectomy
  • Phosphates (blood)
  • Phosphorus, Dietary (blood)

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