HYPERPARATHYROIDISM - DRUGS FOR THE TREATMENT OF HYPERPARATHYROIDISM

Definition

The term hyperparathyroidism refers to a pathology consisting in the excessive quantity 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 parathyroid hormone plays a "very important hyper-calcemizing function at the 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 parathyroid hormone, essentially caused by an increase in the size of the parathyroid glands

Secondary hyperparathyroidism: the hypersecretion of parathyroid hormone is the result of a pathology responsible for the decrease in calcium in the blood (compensatory parathyroid hyperactivity)

Symptoms

Most of the time, hyperparathyroidism is diagnosed randomly, since the symptoms tend to manifest themselves after some time. The symptoms associated with hyperparathyroidism however include heterogeneous disorders: gastric acidity, mood alteration, asthenia, renal colic, difficulty concentration, abdominal pain, bone fragility, nausea, osteoporosis, polyuria, intense and abnormal thirst.

Information on Hyperparathyroidism - Medicines to Treat Hyperparathyroidism is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Hyperparathyroidism - Medicines to Treat Hyperparathyroidism.

Medicines

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 calcium level is not particularly high, the kidneys are able to perform their function correctly, and the bone density is normal or slightly below normal. However, even when the patient is not undergoing any specific treatment, frequent medical supervision is essential, to intervene promptly 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 cure of hyperparathyroidism. primary (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, in order to still maintain some function. "surgical operation, please note:

Need to supplement the diet with calcium and vitamin D.

Damage to the nerves of the vocal cords

In extreme cases, a kidney transplant may be necessary.

Let's now see what are the possible pharmacological treatments that can be undertaken in case of hyperparathyroidism; however, it must be emphasized that only the doctor can indicate the most suitable drug for the patient and the dosage to be followed. The classes of drugs most used in therapy are bisphosphonates (able to counteract bone resorption mediated by osteoclasts and favored by "hyperparathyroidism), and calcium mimetics (act as calcium molecules in the blood, increasing the sensitivity of receptors for the calcium in the parathyroid glands); for postmenopausal women with hyperparathyroidism, drug therapy is supported by estrogen, 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 the drug orally, once a day (possible dose adjustments every 2-4 weeks). The drug works by reducing the secretion of parathyroid hormone; consequently it reduces the calcium level.

Calcitonin (eg. Calcitonin Sandoz, 50-100UI, injectable preparation): it is a parathyroid hormone involved - together with calcitriol, active form of vitamin D - in the homeostasis of phosphorus and calcium. This hormone carries out its therapeutic activity in contrast to that of parathyroid hormone, favoring the reabsorption of calcium and enhancing the renal excretion of phosphorus. It is recommended to take the drug at a dosage of 4-5 IU / kg subcutaneously or intramuscularly, twice a day (every 12 hours). Do not exceed 400-545 IU for each 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 orally, once a day; alternatively, take 2-4 mcg orally, between times per week. The maintenance dose is to be taken. changed every 2-4 intervals per week, based on the concentration of parathyroid hormone in the blood; usually, the dose is increased by 1 mcg per day or 2 mcg per week.

Doxercalciferol: It is recommended to take an initial dose of 10 mcg orally, or 4 mcg intravenously, followed by dialysis three times a week. Thereafter, the dose can be increased from 2.5 mcg orally to 1-2 mcg i.v., every 8 weeks of treatment. Consult your doctor.

Calcitriol (eg. Calcitriol Eg, Calcitriol Hsp, Rocaltrol): it 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 one dose 0.25 mcg of drug orally, once a day, preferably in the morning. The maintenance dose consists in 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.