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Radionuclide-based Diagnosis and Therapy of Prostate Cancer
Published in Michael Ljungberg, Handbook of Nuclear Medicine and Molecular Imaging for Physicists, 2022
Sven-Erik Strand, Mohamed Altai, Joanna Strand, David Ulmert
Bone metastases often lead to pain and fractures. Pain palliation with analgesic or external beam irradiation can have serious side effects. 32P, 89Sr, and 223Ra are so-called calcimimetic agents following calcium kinetics. Radionuclides can be labelled to phosphonates, with high affinity to bone minerals, be absorbed to calcium atoms and reduce pain by inducing apoptosis in osteoclasts. In therapy the most used phosphonate-based agents are 188Re-HEDP, 153Sm-EDTPM, and 177Lu-EDTMP. For bone palliation, 89Sr-chloride [111], 153Sm-lexidronam, and 186Re-etidronate, with pain relief being achieved in 60–80 per cent of patients [112]. Radionuclides used for phosphonate coupling and skeletal pain therapy are given in Lange and colleagues [64]. Table 19.4 lists the main physical characteristics for some radionuclides used for pain palliation in metastatic disease involving the bones.
Management of Parathyroid Cancer
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Calcimimetic agents (e.g. cinacalcet) increase the sensitivity of parathyroid cells to the suppressive effects of high extracellular calcium by binding to calcium-sensing receptors on parathyroid cells.2, 60 Cinacalcet is an oral agent given 30–60 mg daily with a rapid onset of action that reduces calcium within 48 hours and is generally well tolerated.
Multiple endocrine neoplasia *
Published in Demetrius Pertsemlidis, William B. Inabnet III, Michel Gagner, Endocrine Surgery, 2017
The calcimimetic agent cinacalcet has become readily available and, in selected cases, is used to alter or delay the indications for primary or reoperative surgery by lowering serum calcium through stimulation of calcium receptors. However, it is expensive and the long-term efficacy and safety are still being evaluated. It may be strongly considered for use in patients with unlocalized recurrence, rare parathyroid cancer, or significant other medical illness, including widely metastatic neuroendocrine tumors.
An update on phosphate binders for the treatment of hyperphosphatemia in chronic kidney disease patients on dialysis: a review of safety profiles
Published in Expert Opinion on Drug Safety, 2022
Hiroaki Ogata, Akiko Takeshima, Hidetoshi Ito
The results from the LANDMARK study suggest that non-calcium-based phosphate binders are not necessarily preferred over calcium-based phosphate binders for all patients, and calcium-based phosphate binders may be used safely in many patients at restrictive doses. Factors other than calcium load by calcium-based phosphate binders should be considered in detail among dialysis patients. Dietary calcium, dialysate calcium concentration, vitamin D receptor activator use, and influx or efflux of calcium from bone can affect calcium balance in dialysis patients. Calcimimetic use may mitigate calcium load in patients with secondary hyperparathyroidism [64]. In dialysis patients with a lower calcium burden, the appropriate use of calcium-based phosphate binders might be preferable to non-calcium-based phosphate binders. A cross-sectional study demonstrated that calcium-based phosphate binder use was associated with a lower risk of osteoporosis among hemodialysis patients [65]. Currently, the management and treatment of osteoporosis patients with advanced CKD have received much attention because fragility fractures are very prevalent, which also leads to poor outcomes in the general population [66]. In patients undergoing dialysis who receive antiresorptive agents to reduce fracture risk, calcium demand rapidly increases not only because of suppressed bone absorption, but also due to increased bone formation. Calcium-based phosphate binders are more suitable than non-calcium-based phosphate binders for hyperphosphatemia in such cases. In contrast, for patients with previous cardiovascular diseases who have progressive coronary calcification, avoiding calcium overload using non-calcium binders should be mandatory to prevent secondary cardiovascular events.
Feasibility of bipolar radiofrequency ablation in patients with parathyroid adenoma: a first evaluation
Published in International Journal of Hyperthermia, 2018
H. Korkusuz, T. Wolf, F. Grünwald
Current reference standard in the therapy of primary hyperparathyroidism is based upon the surgical removal of the parathyroid adenoma [2]. According to the current guidelines, drug therapy using calcimimetic medication can be considered in individual cases until surgery can be carried out [2]. Parathyroidectomy is performed under general anaesthesia and followed by hospitalization of several days’ duration. Especially for elderly patients, parathyroidectomy and the required anaesthesia are not without risk [3].