Definition
The term hyperparathyroidism refers to a pathology consisting of the excessive amount of parathyroid hormone in the blood, the result of the hyperactivity of one or more of the four parathyroid glands located at the dorsal level of the thyroid. The parathormone has a very important hyper-calcemizing function at bone, intestinal and renal level; therefore, its unregulated increase generates hypercalcemia.
Causes
There are two forms of hyperparathyroidism:
- Primary hyperparathyroidism: derives from an exaggerated synthesis of parathormone, caused essentially by an increase in parathyroid size
- Secondary hyperparathyroidism: parathormone hypersecretion is a consequence of a pathology responsible for the decrease of calcium in the blood (compensatory parathyroid hyperactivity)
Symptoms
Most of the time, hyperparathyroidism is diagnosed by chance, since the symptoms tend to occur after some time. However, the symptoms associated with hyper-parathyroidism include heterogeneous disorders: gastric acidity, mood alteration, asthenia, renal colic, difficulty concentrating, abdominal pain, bone fragility, nausea, osteoporosis, polyuria, intense and abnormal thirst.
Information on Hyperparathyroidism - Drugs for the Treatment of Hyperparathyroidism is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Hyperparathyroidism - Drugs for Hyperparathyroidism.
drugs
The treatment of hyperparathyroidism must be carefully established on the basis of the underlying cause:
- In some patients with mild hyperparathyroidism, the doctor may not even prescribe any treatment: this happens when the symptoms are mild, the level of calcium is not particularly high, the kidneys are able to perform their function correctly, and the bone density is normal or slightly below the norm. However, even when the patient is not subjected to any precise treatment, frequent medical check-ups are essential to promptly intervene as soon as the symptoms worsen.
- Surgery is the most common therapeutic option in case of marked hyperparathyroidism: in this case, it is probably necessary to remove the parathyroid gland responsible for the excessive production of parathyroid hormone. In particular, surgery is the treatment of choice for the treatment of primary hyperparathyroidism (90% of cases). In the event that all four parathyroid glands are diseased, surgery consists in the total removal of three parathyroid glands and a part of the fourth, so as to still maintain some function. Among the most common risks derived from the surgical operation, we recall:
Need to supplement the diet with calcium and vitamin D
Damage to the vocal cord nerves
In extreme cases a kidney transplant may be necessary.
Now let's see what are the possible pharmacological treatments that can be undertaken in case of hyperparathyroidism; however, it should be stressed that only the doctor can indicate the most suitable drug for the patient and the dosage to be followed. The most widely used classes of drugs in therapy are bisphosphonates (able to counter osteoclast-mediated bone resorption and favored by hyperparathyroidism), and calcium-mimetic drugs (they act as calcium molecules in the blood, increasing the sensitivity of receptors for the calcium in parathyroid glands); for postmenopausal women suffering from hyperparathyroidism, drug therapy is supported by estrogen, which is useful for increasing bone density.
- Cinacalcet (eg. Mimpara, 30-60-90 mg tablets): indicated for the treatment of secondary hyperparathyroidism, especially in patients with chronic kidney disease on dialysis, and for the treatment of hyperparathyroidism in the context of parathyroid cancer: the indicative dose is 30 mg of drug per os, once a day (possible dosage adjustments every 2-4 weeks). The drug works by reducing parathyroid hormone secretion; consequently it reduces the calcemia.
- Calcitonin (eg Calcitonin Sandoz, 50-100UI, injectable preparation): it is a parathyroid hormone involved - together with calcitriol, the active form of vitamin D - in the phosphorus and calcium homeostasis. This hormone carries out its therapeutic activity in contrast to that of the parathyroid hormone, favoring the reabsorption of calcium and enhancing renal excretion of phosphorus. It is recommended to take the drug at a dose of 4-5 IU / kg subcutaneously or intramuscularly, twice a day (every 12 hours). Do not exceed 400-545 IU per dose.
- Paricalcitol (eg Zemplar): the drug is an analogue of vitamin D, to be administered orally. The recommended starting dose for the treatment of hyperparathyroidism associated with chronic kidney disease ranges from 1 to 2 mcg per os, once a day; alternatively, take 2-4 mcg per os, between times a week. The maintenance dose should be changed every 2-4 intervals per week, based on the concentration of parathyroid hormone in the blood; in general, the dose is increased by 1 mcg per day or 2 mcg per week.
- Doxercalciferol: it is recommended to take an initial dose of drug equal to 10 mcg per os, or 4 mcg intravenously, followed by dialysis three times a week. Subsequently, it is possible to increase the dose from 2.5 mcg per os to 1-2 mcg ev, every 8 weeks of treatment. Consult your doctor.
- Calcitriol (eg Calcitriolo Eg, Calcitriolo Hsp, Rocaltrol): this is the active form of vitamin D3: this acts by promoting the absorption of calcium and phosphorus, and inhibiting the release of calcitonin. It is recommended to start therapy with a dose of 0.25 mcg of drug per os once a day, preferably in the morning. The maintenance dose consists of increasing each dose by 0.25 mcg / day, in 2-4 intervals. This drug is indicated for the treatment of hyperparathyroidism associated with kidney disease.
