New strategies for the treatment of secondary hyperparathyroidism.
Classic pathogeneses of secondary hyperparathyroidism (2HPT), hyperphosphatemia, vitamin D deficiency, and hypocalcemia, have been treated by the administration of phosphorus binders and vitamin D derivatives. However, these therapies have not brought about a successful result. The main reason could be attributed to hypercalcemia resulting from the administration of calcium salts as a phosphorus binder and the calcemic action of vitamin D. To prevent hypercalcemia, non-calcium-containing phosphorus binders and vitamin D analogues, which suppress parathyroid hormone (PTH) secretion with minimum calcemic action, have been developed. Furthermore, calcimimetics that stimulate the calcium-sensing receptor of parathyroid cells and suppress PTH secretion are now under clinical trial. Direct injection therapy of vitamin D analogues or calcimimetics into the parathyroid gland also has been reported. These new strategies are expected to effectively and safely suppress 2HPT, which has been resistant to conventional medical treatments.
Akizawa
Tadao
T
Center of Blood Purification Therapy, First Department of Pathology, Wakayama Medical University, Wakayama, Japan. akizawa@wakayama-med.ac.jp
Shiizaki
Kazuhiro
K
Hatamura
Ikuji
I
Kamimura
Motohiro
M
Mizobuchi
Masahide
M
Narukawa
Nobuhiko
N
Sumikado
Shinji
S
Sakaguchi
Toshibumi
T
Negi
Shigeo
S
Ogata
Hiroaki
H
Kinugasa
Eriko
E
D000818:Animals; D004852:Epoxy Compounds / Q000627:therapeutic use; D006801:Humans; D006961:Hyperparathyroidism / Q000188:drug therapy* / Q000209:etiology; D010758:Phosphorus / Q000378:metabolism; D011073:Polyamines; D011095:Polyethylenes / Q000627:therapeutic use; D000069603:Sevelamer; D014807:Vitamin D / Q000031:analogs & derivatives / Q000627:therapeutic use
D004852:Epoxy Compounds; D011073:Polyamines; D011095:Polyethylenes; D014807:Vitamin D; D010758:Phosphorus; D000069603:Sevelamer