Tumours of the parathyroid glands

作者：Laubner K; Thomusch O; Seufert J^*

来源：Onkologe, 2013, 19(6): 505-511.

DOI：10.1007/s00761-012-2392-x

• Primary hyperparathyroidism
• Parathyroid adenoma
• Parathyroid carcinoma
• Hypercalcemia
• Calcimimetic drugs

Benign and rarely malignant tumors of the parathyroid glands cause primary hyperparathyroidism (pHPT) which is the third most prevalent endocrine disease after type 2 diabetes mellitus and hyperthyroidism. %26lt;br%26gt;A systematic literature search was performed in Pubmed, MEDLINE, current guidelines and by manual searching. Relevant publications from the past 5 years were analyzed and results were summarized in a structured review. %26lt;br%26gt;In 80-90 % of cases pHPT results from a single parathyroid adenoma, in 10-20 % of cases multiple adenomas or diffuse hyperplasia of all parathyroid glands are found, in particular in familial tumor syndromes. Parathyroid carcinomas are found in less than 1 % of cases. Symptoms of pHPT are characterized by direct parathyroid hormone (PTH) effects in target organs and later by hypercalcemia-associated organ complications. Diagnostic procedures include laboratory tests (e.g. calcium, phosphate and PTH) and imaging procedures, e.g. ultrasound and methoxyisobutylisonitrile (sestamibi) scintigraphy for localization of the tumor. The goal of therapeutic interventions in pHPT and parathyroid tumors is normalization of the serum calcium concentrations with alleviation of any pHPT-associated symptoms and to cure the tumor. Symptomatic patients and carcinomas should be surgically treated by parathyroidectomy in specialized centres. In 95 % of patients with adenomas these can be cured by a primary surgical intervention. In parathyroid carcinoma patients survival is approximately 80 % after 5 years and 70 % after 10 years. In asymptomatic patients with pHPT a non-surgical approach may be justified. When the perioperative risk is high or in nonoperable carcinoma patients, treatment with calcimimetic drugs (cinacalcet) represents a highly effective drug therapy for normalization of serum calcium levels. %26lt;br%26gt;Tumors of the parathyroid glands are largely benign adenomas and rarely carcinomas which can be cured in most cases by primary surgical intervention. This intervention also cures the concomitantly occurring pHPT. For non-surgical treatment strategies, calcimimetic agents are available to lower serum calcium concentrations.

• 出版日期2013-6