| Theme |
Evidence-based strategies for secondary hyperparathyroidism |
| Title |
Utilizing information from routine examinations to ascertain limits of medical therapy |
| Author |
Fumihiko Koiwa |
Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital |
| Author |
Daisuke Komukai |
Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital |
| [ Summary ] |
Severe bone diseases such as advanced osteitis fibrosa, and extra skeletal calcifications due to disturbance in calcium and phosphorus metabolism are thought to result in secondary hyperparathyroidism resistant to medical treatment. Calcification of blood vessels and valves progresses irreversibly, causing cardiovascular complications. It is important to utilize routine examinations such as checks of serum calcium, phosphorus levels, and intact PTH to ascertain the limits of medical treatment. Target level of calcium X phosphorus products were set at relative low levels in the new guidelines in Europe and United States, because of a desire for prevention of increases in cardiovascular calcification and mortality risk factors. Although complications from secondary hyperparathyroidism other than ectopic calcifications need to be evaluated by particular methods, measurement of parathyroid gland volume by ultrasonic examination has become a useful index to ascertain the limits of medical treatment. |