Does vitamin D receptor and calcium receptor activation therapy play a role in the histopathologic alterations of parathyroid glands in refractory uremic hyperparathyroidism?
OBJECTIVE
Vitamin D receptor activation by vitamin D sterols and calcium-sensing receptor stimulation by cinacalcet are the most powerful treatments of secondary hyperparathyroidism. This study was aimed to assess a possible association between histopathologic changes of parathyroid tissue and treatment modality.


METHODS
Studies were performed on 82 parathyroids of 22 adult white hemodialysis patients undergoing first parathyroidectomy. The type of hyperplasia and the distribution of chief and oxyphil cells, expressed as oxyphil/chief cell ratio, were assessed. Three groups could be studied according to treatment modality: group A consisted of 6 patients who were treated with cinacalcet, intravenous calcitriol, and phosphate binders; group B consisted of 6 patients who were treated with intravenous calcitriol and phosphate binders, and group C consisted of 10 patients who were treated with phosphate binders alone.


RESULTS
Sixty-eight (82.9%) out of 82 glands removed showed nodular hyperplasia. It was more frequent in groups A and B than in group C. A stepwise forward logistic regression model showed that the probability of nodular hyperplasia was higher in patients who were on calcitriol and/or cinacalcet therapy, in female gender and in patients with a higher body mass index. Oxyphil/chief cell ratio also was significantly different among the three groups. Cinacalcet treatment was the only predictor of this ratio.


CONCLUSIONS
An association was found between calcitriol and/or cinacalcet therapy and a high prevalence of nodular hyperplasia, and between cinacalcet therapy and high oxyphil/chief cell ratio. The meaning of the observed associations remains uncertain.
Lomonte
Carlo
C
Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti, Manduria, Italy.
Vernaglione
Luigi
L
Chimienti
Domenico
D
Bruno
Andrea
A
Cocola
Savino
S
Teutonico
Annalisa
A
Cazzato
Francesco
F
Basile
Carlo
C
D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002117:Calcitriol / Q000009:adverse effects / Q000627:therapeutic use*; D000069449:Cinacalcet; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology / Q000601:surgery; D006965:Hyperplasia; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000009:adverse effects / Q000627:therapeutic use*; D024862:Oxyphil Cells / Q000187:drug effects / Q000473:pathology; D010280:Parathyroid Glands / Q000187:drug effects* / Q000473:pathology / Q000601:surgery; D016105:Parathyroidectomy; D010710:Phosphates / Q000627:therapeutic use; D018167:Receptors, Calcitriol / Q000819:agonists*; D044169:Receptors, Calcium-Sensing / Q000819:agonists*; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D017211:Treatment Failure; D014511:Uremia / Q000150:complications* / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D014815:Vitamins / Q000009:adverse effects / Q000627:therapeutic use*
D009281:Naphthalenes; D010710:Phosphates; D018167:Receptors, Calcitriol; D044169:Receptors, Calcium-Sensing; D014815:Vitamins; D002117:Calcitriol; D000069449:Cinacalcet