Der osteologische Patient mit primärem Hyperparathyreoidismus

Zusammenfassung

Beim primären Hyperparathyreoidismus (pHPT) handelt es sich um eine autonome Sekretion von PTH aus einem oder mehreren meist adenomatös veränderten Epithelkörperchen. Seltene Differenzialdiagnose ist die FHH (familiäre hypokalziurische Hyperkalzämie). Der pHPT ist eine häufige Endokrinopathie, es sind überwiegend Frauen betroffen. Das Bild des pHPT hat sich in den letzten Jahrzehnten entscheidend gewandelt. Die meisten Patienten fallen heute zufällig durch eine Labordiagnostik auf und weisen kaum Symptome auf. Dennoch geht auch der asymptomatische pHPT mit einer erhöhten Frakturrate einher. Prinzipiell sollte allen Patienten mit gesichertem pHPT eine definitive Therapie (Operation) angeboten werden. Für asymptomatische Patienten sind durch Leitlinien Kriterien festgelegt worden, die ein abwartendes Verhalten rechtfertigen. Bei konservativem Therapieansatz werden vor allem Bisphosphonate eingesetzt. So führt Alendronsäure zu einem minimalem Abfall des Serumkalziums sowie einer Zunahme der Knochendichte. Die Behandlung mit Cinacalcet ist Patienten, die nicht einer Operation unterzogen werden können und bei denen die Hyperkalzämie im Vordergrund steht, vorbehalten.

Summary

Primary hyperparathyroidism (pHPT) is due to an autonomous secretion of parathyroid hormone by one or more parathyroids. It is a frequent endocrine disorder which affects predominantly females. The clinical picture has changed during the last decades, as nowadays most patients are asymptomatic and diagnosed by routine laboratory tests. However even in those cases an increased fracture rate can be observed. An important differential diagnosis is the familial hypocalciuric hypercalcemia. All patients with pHPT should be offered a surgical cure. Guidelines indicate in which asymptomatic patients a “wait and see” approach is justified. Medical therapy with bisphosphonates (alendronic acid) can slightly reduce calcium and significantly improve bone density. Cinacalcet results in a pronounced reduction of serum calcium in patients who cannot undergo surgery.

Schlüsselwörter

Primärer Hyperparathyreoidismus - multiple endokrine Neoplasie - Osteoporose - familiäre hypokalziurische Hyperkalzämie

Keywords

Primary hyperparathyroidism - multiple endocrine neoplasia - osteoporosis - familial hypocalciuric hypercalcemia

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