| 特集名 | シナカルセト塩酸塩 | |
|---|---|---|
| 題名 | 副甲状腺インターペンションとシナカルセト塩酸塩 | |
| 発刊年月 | 2008年 04月 | |
| 著者 | 冨永 芳博 | 名古屋第二赤十字病院移植・内分泌外科 |
| 【 要旨 】 | シナカルセト塩酸塩の出現は，わが国の二次性副甲状腺 (上皮小体) 機能亢進症 (HPT) の治療方針にも少なからず影響を与えると考えられる．原則的には，シナカルセト塩酸塩を含めた内科的治療に抵抗する症例は副甲状腺インターベンションの適応となる．わが国では長期間の血液透析を要する症例が多いため，長期的展望，経済性も含め，副甲状腺インターペンションの適応を考えるべきである．また，過形成のパターンとシナカルセト塩酸塩の反応性など検討すべき点が多々存在する．一方，手術でHPTを改善させることが困難な病態が存在する．つまり，(1) 手術，全身麻酔の侵襲に耐えられない症例，(2) 縦隔内など異所性副甲状腺の切除が困難な症例，(3) PTH過剰分泌originが同定できない症例，(4) 副甲状腺癌，parathyromatosisなどすべての病的副甲状腺組織を切除困難な症例，(5) 再手術により両側反回神経麻痺など重大な合併症を引き起こす可能性がある症例，などである．それらの症例にはシナカルセト塩酸塩は良い適応と考えられる．原発性HPTの副甲状腺癌で手術不能による高カルシウム血症に対して欧米ではシナカルセト塩酸塩が認可されており，わが国でも一刻も早く使用できることを期待したい． | |
| Theme | Cinacalcet hydrochloride | |
|---|---|---|
| Title | Parathyroid intervention therapy and cinacalcet hydrochloride for advanced secondary hyperparathyroidism due to chronic kidney disease | |
| Author | Yoshihiro Tominaga | Department of Transplant and Endocrine Surgery, Nagoya Second Red Cross Hospital |
| [ Summary ] | Cinacalcet hydrochloride should have an impact on the treatment of secondary hyperparathyroidism (HPT) due to chronic kidney disease (CKD) in Japan. However, there are many issues to be resolved about the treatment. Special consideration should be made as to efficacy of cinacalcet hydrochloride for treatment of nodular hyperplasia, in relation to parathyroid intervention therapy. Parathyroidectomy (PTx) can dramatically control secondary HPT in most cases. However, surgeons hesitate to perform this operation on patients who belong to high risk groups having the possibility of severe complications, ie bilateral recurrent nerve palsy. Sometimes removal of the parathyroid gland located ectopically, especially in the mediastinum, may be invasive. Parathyroid carcinoma or parathyromatosis often can not be controlled even through surgical measures. Cinacalcet hydrochloride may be indicated for these patients, producing a remarkable decrease in high PTH levels. Calcimimetics are available in the USA and European countries for patients with uncontrollable hypercalcemia due to parathyroid carcinoma. In Japan the acceptance of this medicine for parathyroid carcinoma is expected soon. After the induction of cinacalcet hydrochloride, successful surgical treatment may also be required. |
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