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DOI: 10.1055/s-0030-1267477
© Georg Thieme Verlag KG Stuttgart · New York
Primärer Hyperparathyreoidismus
Primary hyperparathyroidismPublication History
eingereicht: 13.2.2010
akzeptiert: 1.7.2010
Publication Date:
05 October 2010 (online)

Zusammenfassung
Der primäre Hyperparathyreoidismus ist eine häufige endokrine Erkrankung. Die Einführung der routinemäßigen Kalziumbestimmung im Serum am Automaten hat zu dieser Inzidenzzunahme geführt. Die klassischen klinischen Symptome wie Nierensteine, ossäre Symptome oder gastrointestinale Erkrankungen spielen heute eine untergeordnete Rolle, so dass die Hyperkalzämie mit erhöhtem intaktem Parathormon die Diagnose zu 95 % sichern. Da die asymptomatische Verlaufsform über 80 % der Fälle ausmacht, wurden Kriterien für die chirurgische Therapie in Konsensuskonferenzen beraten und publiziert. Nach gesicherter biochemischer Diagnose werden als Lokalisationsdiagnostik der Halsultraschall und die 99m Tc-Sestamibi-Szintigraphie favorisiert. Die jetzt verbesserte Diagnostik hat auch zu weniger belastenden chirurgischen Methoden mit minimal-invasiven und endoskopischen Techniken geführt. Darüber hinaus ist durch die schnelle intraoperative Parathormonbestimmung eine unmittelbare Erfolgskontrolle des Eingriffs möglich. Bei leichteren asymptomatischen Formen bei älteren Patienten ist durchaus eine Verlaufsbeobachtung gerechtfertigt. Als medikamentöse Therapien haben sich vor allem Bisphosphonate bei ossärer Beteiligung und zur Senkung des Kalzium- und Parathormonspiegels unter bestimmten Voraussetzungen Cinacalcet bewährt.
Abstract
Primary hyperparathyroidism is a common endocrine disease. Since introduction of automated routine measurement of serum calcium the detection of primary hyperparathyroidism has increased significantly. The classical symptoms such as kidney stones, gastrointestinal and bone manifestation are rarely seen nowadays. For this reason, an elevated parathyroid hormone level in a patient with hypercalcemia confirms primary hyperparathyroidism in 95 % of cases. Currently 80 % of these patients are asymptomatic, and therefore criteria for diagnosis and treatment have been discussed on several consensus conferences. After biochemical confirmation has been obtained further diagnostic test aim at locating the tumor should be by ultrasound and 99m TC-sestamibi scintigraphy. The improved diagnostic work-up had led to a better surgical approach with minimally invasive and endoscopic techniques. In addition, quick intraoperative parathyroid hormone measurements confirm immediately the success of surgical treatment. Non-surgical treatment in asymptomatic and elderly patients may be justified. Bisphosphonates are the first choice for medical treatment in patients with bone manifestation and cinacalcet may be given to patients to lower calcium and parathyroid hormone levels.
Schlüsselwörter
primärer Hyperparathyreoidismus - Parathormon - Hyperkalzämie - Nebenschilddrüse
Keywords
primary hyperparathyroidism - parathyroid hormone - parathyroid gland - hypercalcemia
Literatur
- 1
Bilezikian J P, Khan A A, Potts Jr J T.
Guidelines for the
management of asymptomatic primary hyperparathyroidism: summary
statement from the third international workshop.
J Clin
Endocrinol Metab.
2009;
94
335-339
MissingFormLabel
- 2
Bilezikian J P, Potts Jr J T, Fuleihan G. et al .
Summary statement from a workshop
on asymptomatic primary hyperparathyroidism: a perspective for the
21st century.
J Clin Endocrinol Metab.
2002;
87
5353-5361
MissingFormLabel
- 3
Bilezikian J P, Silverberg S J.
Clinical
practice. Asymptomatic primary hyperparathyroidism.
N
Engl J Med.
2004;
350
1746-1751
MissingFormLabel
- 4
Chen H, Mack E, Starling J R.
A comprehensive evaluation of perioperative adjuncts during
minimally invasive parathyroidectomy: which is most reliable?.
Ann Surg.
2005;
242
375-380
MissingFormLabel
- 5
DeLellis R A, Mazzaglia P, Mangray S.
Primary hyperparathyroidism: a current perspective.
Arch
Pathol Lab Med.
2008;
132
1251-1262
MissingFormLabel
- 6
Eastell R, Arnold A, Brandi M L. et al .
Diagnosis of asymptomatic primary hyperparathyroidism:
proceedings of the third international workshop.
J Clin
Endocrinol Metab.
2009;
94
340-350
MissingFormLabel
- 7
Grey A, Lucas J, Horne A, Gamble G, Davidson J S, Reid I R.
Vitamin D repletion in patients
with primary hyperparathyroidism and coexistent vitamin D insufficiency.
J Clin Endocrinol Metab.
2005;
90
2122-2126
MissingFormLabel
- 8
Guthoff M, Georges G, Wehrmann M. et al .
Hyperkalzämische Krise infolge
eines primären Hyperparathyreoidismus.
Dtsch
Med Wochenschr.
2008;
133
2639-2643
MissingFormLabel
- 9
Horger M, Bares R, Vogel M, Mussig K.
Bildgebende Diagnostik des Hyperparathyroidismus.
Fortschr Röntgenstr.
2007;
179
205-207
MissingFormLabel
- 10
Khan A, Grey A, Shoback D.
Medical management of asymptomatic primary hyperparathyroidism:
proceedings of the third international workshop.
J Clin
Endocrinol Metab.
2009;
94
373-381
MissingFormLabel
- 11
Khan A A, Bilezikian J P, Kung A, Dubois S J, Standish T I, Syed Z A.
Alendronate
therapy in men with primary hyperparathyroidism.
Endocr Pract.
2009;
15
705-713
MissingFormLabel
- 12
Khoo T K, Vege S S, bu-Lebdeh H S, Ryu E, Nadeem S, Wermers R A.
Acute pancreatitis
in primary hyperparathyroidism: a population-based study.
J
Clin Endocrinol Metab.
2009;
94
2115-2118
MissingFormLabel
- 13
Moosgaard B, Vestergaard P, Heickendorff L, Melsen F, Christiansen P, Mosekilde L.
Vitamin D status,
seasonal variations, parathyroid adenoma weight and bone mineral
density in primary hyperparathyroidism.
Clin Endocrinol
(Oxf).
2005;
63
506-513
MissingFormLabel
- 14
Nussbaum S R, Zahradnik R J, Lavigne J R. et al .
Highly sensitive two-site immunoradiometric
assay of parathyrin, and its clinical utility in evaluating patients
with hypercalcemia.
Clin Chem.
1987;
33
1364-1367
MissingFormLabel
- 15
Peacock M, Bilezikian J P, Klassen P S, Guo M D, Turner S A, Shoback D.
Cinacalcet hydrochloride maintains long-term normocalcemia in
patients with primary hyperparathyroidism.
J Clin Endocrinol
Metab.
2005;
90
135-141
MissingFormLabel
- 16
Pfeilschifter J.
Hypercalcämische Krise.
Internist (Berl).
2003;
44
1231-1236
MissingFormLabel
- 17
Rao D S, Phillips E R, Divine G W, Talpos G B.
Randomized
controlled clinical trial of surgery versus no surgery in patients
with mild asymptomatic primary hyperparathyroidism.
J
Clin Endocrinol Metab.
2004;
89
5415-5422
MissingFormLabel
- 18
Rubin M R, Bilezikian J P, McMahon D J. et al .
The natural history
of primary hyperparathyroidism with or without parathyroid surgery
after 15 years.
J Clin Endocrinol Metab.
2008;
93
3462-3470
MissingFormLabel
- 19
Russell C F, Dolan S J, Laird J D.
Randomized clinical trial comparing scan-directed
unilateral versus bilateral cervical exploration for primary hyperparathyroidism
due to solitary adenoma.
Br J Surg.
2006;
93
418-421
MissingFormLabel
- 20
Silverberg S J.
Vitamin D deficiency and primary hyperparathyroidism.
J
Bone Miner Res.
2007;
22 Suppl 2
V100-V104
MissingFormLabel
- 21
Silverberg S J, Lewiecki E M, Mosekilde L, Peacock M, Rubin M R.
Presentation of asymptomatic primary
hyperparathyroidism: proceedings of the third international workshop.
J Clin Endocrinol Metab.
2009;
94
351-365
MissingFormLabel
- 22
Silverberg S J, Rubin M R, Faiman C. et al .
Cinacalcet hydrochloride reduces the serum
calcium concentration in inoperable parathyroid carcinoma.
J
Clin Endocrinol Metab.
2007;
92
3803-3808
MissingFormLabel
- 23
Udelsman R, Pasieka J L, Sturgeon C, Young J E, Clark O H.
Surgery for asymptomatic primary hyperparathyroidism:
proceedings of the third international workshop.
J Clin
Endocrinol Metab.
2009;
94
366-372
MissingFormLabel
- 24
Wermers R A, Khosla S, Atkinson E J. et al .
Incidence of primary hyperparathyroidism
in Rochester, Minnesota, 1993 – 2001:
an update on the changing epidemiology of the disease.
J
Bone Miner Res.
2006;
21
171-177
MissingFormLabel
- 25
Westerdahl J, Bergenfelz A.
Unilateral versus
bilateral neck exploration for primary hyperparathyroidism: five-year
follow-up of a randomized controlled trial.
Ann Surg.
2007;
246
976-980
MissingFormLabel
PD Dr. med. Marcus Quinkler
Klinische Endokrinologie
Charité Campus
Mitte
Charité Universitätsmedizin Berlin
Charitéplatz 1
10117 Berlin
Phone: 030/450-514152
Fax: 030/450-514952
Email: marcus.quinkler@charite.de