title: Use of ultrasound to assess the response to therapy for secondary hyperparathyroidism.
abstract: Secondary hyperparathyroidism (SHPT) is a common complication in patients with chronic kidney disease. In SHPT, the biology of parathyroid cells changes significantly toward diffuse nodular hyperplasia. Currently, diagnosis of SHPT is based on intact parathyroid hormone serum levels and parameters of mineral metabolism. The morphologic diagnosis of SHPT relies on high-resolution ultrasonography with color Doppler imaging. This report describes a maintenance hemodialysis patient with severe SHPT treated using conventional therapy (phosphate binders and oral/intravenous vitamin D or analogues) and the subsequent addition of a calcimimetic. The role of color Doppler ultrasonography in the diagnosis, clinical follow-up, and assessment of therapeutic response of SHPT is discussed. This case suggests that the availability of calcimimetics has changed the natural history of clinical SHPT and may change the therapeutic utility of parathyroidectomy. Use of color Doppler ultrasonography further supports these therapeutic advances, allowing evaluation of the morphologic and vascular changes in hyperplastic parathyroid glands and aiding clinical, pharmacologic, and surgical strategies.
authors.affiliation: S. Anna School of Advanced Studies, Department of Internal Medicine, University of Pisa, Italy. mmeola@int.med.unipi.it
authors.forename: Mario
authors.initials: M
authors.lastname: Meola
authors.forename: Ilaria
authors.initials: I
authors.lastname: Petrucci
authors.forename: Elisa
authors.initials: E
authors.lastname: Colombini
authors.forename: Giuliano
authors.initials: G
authors.lastname: Barsotti
mesh_terms: D000069449:Cinacalcet; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D006965:Hyperplasia; D008875:Middle Aged; D009281:Naphthalenes / Q000627:therapeutic use; D010280:Parathyroid Glands / Q000000981:diagnostic imaging / Q000473:pathology; D010281:Parathyroid Hormone / Q000097:blood; D006435:Renal Dialysis; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color
chemical_list: D009281:Naphthalenes; D010281:Parathyroid Hormone; D000069449:Cinacalcet