China
Africa
Explore chapters and articles related to this topic
Surgical Failure and Reoperative Surgery
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
Schelto Kruijff, Leigh Delbridge
For acute treatment of severe hypercalcaemia, intravenous saline solution loop, diuresis and bisphosphonates are recommended.26 Subcutaneous calcitonin is also an option, but its efficacy is limited to the first 2 days. Cinacalcet is a calcimimetic drug and lowers PTH secretion by enhancing receptor sensitivity to extracellular calcium. Normocalcaemia can be achieved after 1 day of treatment, the response to cinacalcet can be persistent and it is generally well tolerated.30 The drug has been shown to be effective in reducing or normalizing serum calcium levels in several groups of patients with PHPT, including patients with mild to moderate PHPT, parathyroid carcinoma, and in PHPT as a part of MEN type 1.27 Cinacalcet at low dosages is well tolerated, but side effects are more frequent and severe when relatively high doses are needed to control hypercalcaemia. The most common adverse events are nausea, vomiting and paresthesias.26 Cinacalcet may be of benefit in a wide spectrum of PHPT, offering a novel therapeutic option for the control of hypercalcaemia in PHPT patients who are not able to undergo parathyroidectomy. To what extent the reduction of serum calcium translates into a clinical benefit, particularly in patients with mild to moderate hypercalcaemia, is currently unknown.28
Endocrine emergencies
Published in Philip E. Harris, Pierre-Marc G. Bouloux, Endocrinology in Clinical Practice, 2014
Treatment of the underlying cause, such as parathy-roidectomy, should be considered. Steroids are effective in the treatment of hypercalcemia caused by vitamin D intoxication, granulomatous disease, and myeloma, but they are not recommended outside of these circumstances. Cinacalcet is a calcium mimetic that can be used to lower serum calcium levels in hyperparathyroidism caused by parathyroid cancer.
Hypercalcemia and hyperparathyroidism
Published in Nadia Barghouthi, Jessica Perini, Endocrine Diseases in Pregnancy and the Postpartum Period, 2021
Pharmacologic treatments of hypercalcemia have not been adequately studied nor approved in pregnancy. Clinical experience with pharmacologic therapies is limited to individual case reports so the relative benefits and risks of each option are not clear. Therefore, parathyroidectomy is the only definitive treatment of PHPT.Calcitonin (pregnancy category B) does not cross the placenta and has been used in pregnancy to suppress bone resorption and promote urine calcium excretion. It may be used acutely and effectively in the short term but loses its efficacy due to tachyphylaxis.Oral phosphate (pregnancy category C) has been used in pregnancy with modest efficacy to bind calcium. The most common side effects are diarrhea and hypokalemia.Bisphosphonate therapy is contraindicated in pregnancy as these medications cross the placenta and may interfere with fetal endochondral bone development.5Cinacalcet (pregnancy category C) has been used in pregnancy in at least 1 case.5 This medication acts on the calcium receptor to suppress PTH and stimulate calcitonin, thereby lowering serum calcium levels. Its use in pregnancy is limited by the side effect of nausea. In addition, the calcium receptor is also expressed in the placenta and fetal parathyroid glands, so cinacalcet may also suppress the fetal parathyroid glands, stimulate fetal calcitonin, and alter the rate of placental calcium transfer.High-dose magnesium also acts on the calcium receptor to decrease PTH and calcium.
Limitations of standard cost-effectiveness methods for health technology assessment of treatments for rare, chronic diseases: a case study of treatment for cystic fibrosis
Published in Journal of Medical Economics, 2022
Jaime L. Rubin, Andrea Lopez, Jason Booth, Penilla Gunther, Anupam B. Jena
Inclusion of ongoing disease management costs when life is extended by novel treatments reduces the cost-effectiveness of drugs in a way that is counter to the value most people would attribute to increased survival. In the most extreme cases, a life-extending treatment may not be considered cost-effective even when priced at $0. This was the case in the NICE evaluation of cinacalcet, a treatment for secondary hyperparathyroidism in patients with end-stage renal disease on maintenance dialysis. Because the treatment is projected to modestly extend life, and patients still require dialysis during this extended period, the additional costs associated with maintenance dialysis outweigh the additional QALYs gained. Because of this, the therapy would not be considered cost-effective even if the price were $049. This is an extreme but important example of how standard inclusion of disease management costs can produce an unrealistic valuation of life-extending products for chronic diseases. In our case study, omitting additional disease management costs during the period of additional survival attributable to ELX/TEZ/IVA reduced the ICER by 10%. Our case study for ELX/TEZ/IVA did not assume direct reductions in costs associated with standard of care treatment (e.g. reductions in cost per PEx episode or symptomatic therapies). This was likely a conservative assumption based on emerging evidence50,51, and the inclusion of additional direct cost-offsets would reduce the impact of costs incurred during the additional years of survival.
Relation of hyperparathyroidism and hypercalcemia to bipolar and psychotic disorders
Published in Baylor University Medical Center Proceedings, 2022
Chioma O. Enyi, Brendan D’Souza, Linda Barloon, Onyedika J. Ilonze, Ranjit Chacko
Annual calcium and PTH level screening for patients on chronic lithium therapy has been recommended.20,21 Management of lithium-induced HPT includes parathyroidectomy, lithium discontinuation, monitored lithium continuation, and calcimimetic therapy. Cinacalcet is used for symptomatic patients when lithium discontinuation poses psychiatric risks and surgical intervention has failed or is contraindicated.22 Psychiatrists can be instrumental in performing screening calcium tests and detecting HPT in patients with psychiatric illness, especially with unclear or inexplicable changes in mental status (Figure 1). Medical management, such as lithium discontinuation, has the potential to resolve PHPT. Based on our limited experience, we recommend parathyroidectomy for patients with PHPT who experience severe psychiatric symptoms, in addition to medical therapy. Patients with psychiatric symptoms due to HPT have significant morbidity and reduced quality of life, and the current evidence suggests that neuropsychiatric symptoms seen in HPT improve with parathyroidectomy, which is the only known cure of PHPT.
Electrolytes disturbances after kidney transplantation
Published in Acta Clinica Belgica, 2019
Liesbeth De Waele, Pieter-Jan Van Gaal, Daniel Abramowicz
Initially, in case of asymptomatic, mild hypercalcemia, watchful waiting is an option, mainly in the first year after transplantation. In case of severe, persistent or symptomatic hypercalcemia, treatment options are calcimimetics (cinacalcet) or parathyroidectomy (subtotal vs. total with or without autotransplantation) [47]. Bisphosphonates, used in the classical treatment of hypercalcemia, is not a preferred choice in renal transplant recipients, as it may lead to adynamic bone disease despite preservation of bone mineral density [48]. A systematic review and meta-analysis demonstrated that the use of cinacalcet appeared to be safe and effective for treatment of posttransplant hyperparathyroidism [49]. Parathyroidectomy is a very efficient treatment to correct hypercalcemia and treat hyperparathyroidism. A retrospective review demonstrated that near total parathyroidectomy leads to resolution of hypercalcemia in 97% of patients at a median follow-up of 3 years. In 80% of patients, PTH levels fell to <250 pg/ml [50]. Optimal timing of parathyroidectomy is a matter of discussion. Some centers opt to perform a parathyroidectomy during the time on the waiting list in patients with pre-transplant hypercalcemia or severe secondary hyperparathyroidism.