Medicinal treatment of primary hyperparathyroidism

Abstract

Primary hyperparathyroidism (PHPT) is a hyperproduction of parathyroid hormone that is not provoked by a decrease in the blood calcium level, which leads to a violation of calcium homeostasis. The prevalence of PHPT has been increasing over the past 10 years due to improvements in its diagnosis. Currently, it ranks third by this indicator after diabetes and thyroid patho­logy. The leading clinical manifestations of PHPT are demineralization and resorption of bone tissue, as well as nephrolithiasis and the development of renal failure. It was found that a decrease in the glomerular filtration rate is inversely correlated with the level of parathyroid hormone and is associated with a greater decrease in bone mineral density. In addition, the frequency of left ventricular hypertrophy increases against the background of a significant persistent increase in calcium. Patients with the indicated symptoms due to an unestablished PHPT are under the supervision of orthopedists, cardiologists, and family doctors. Monitoring of PHPT is not a fully addressed issue today. This, in particular, is due to the fact that the functioning organizational system for the diagnosis of this pathology has significantly increased both the number of identified patients and the proportion of asymptomatic PHPT among them. Some people refuse surgery, which is currently recognized as the best option for the treatment of PHPT. Other patients have contraindications to surgery due to severe comorbid pathology. These factors increase the relevance for the development of the princip­les of medicinal treatment of pathology, which requires a serious analysis of existing drugs, their therapeutic potential, and the risk of complications in order to develop clinical recommendations. These questions became the basis of this review article. The base of scientific publications on PHPT and pharmacological aspects of the action of drugs in patients with this pathology were analyzed. It was found that among the full-text articles with the analysis of the­rapy effectiveness, the most common drugs of choice were bisphosphonates, calcimimetic cinacalcet, vitamin D and its analogues. Their prospects for the impact on the main symptoms of PHPT are carefully considered. The results of the analysis will allow clinicians to choose individual treatment approach to a particular patient.

Keywords

• primary hyperparathyroidism
• bisphosphonates
• calcimimetic
• vitamin d