만성 신부전증 환자에서 속발된 이차성 부갑상선 기능항진증 1예 보고

• 영문명: Secondary Hyperparathyroidism Associated with End Stage Renal Disease (ESRD): A Case Report
• 발행기관: 대한내분비외과학회
• 저자명: 민선영 최재영 송정윤 고석환 Sun Young Min M.D. Jae Young Choi M.D. Jeong Yoon Song M.D. and Suck Hwan Koh M.D.
• 간행물 정보: 『The Koreran journal of Endocrine Surgery』7권1호, 34~38쪽, 전체 5쪽
• 주제분류: 의약학 > 일반외과학
• 파일형태: PDF
• 발행일자: 2007.03.31

영문 초록

In contrast to the intrinsic feedback inhibition defect of primary hyperparathyroidism (HPT), secondary HPT is caused by chronic extrinsic overstimulation of otherwise normal parathyroid glands. This condition is very common in patients with end stage renal disease (ESRD), and secondary HPT develops as a complex sequence of interactions. As the glomerular filtration rate falls, the renal production of 1,23- dihydroxy-vitamin D3 decreases. Moreover, this causes a reduction in intestinal calcium absorption, which creates the parathyroid hormone (PTH) secretion. This secretion increases serum calcium levels by mobilizing calcium from bones. Lastly, the PTH secretion is further stimulated by hyperphosphatemia (via a phosphorous-specific receptor) and a decrease in ionized calcium (from reduced solubility caused by hyperphosphatemia). Intact PTH levels of 500 to 1,500 pg/ml are common (normal: 10∼65 pg/ml) in ESRD patients. Long-standing hyperphosphatemia contributes to the alteration of the parathyroid cells, which affect feedback inhibition, due to an increase in ionized calcium. Secondary HPT is mainly controlled by the restriction of phosphate, the inhibition of phosphorous absorption and the supplementation of calcitriol. Secondary HPT, which is unresponsive to medical treatment, it is well known that a total parathyroidectomy and autotransplantation has good results. This report documents our experience with secondary HPT, treated with a total parathyroidectomy and autotransplantation. (Korean J Endocrine Surg 2007;7:34-38)

키워드

2차성 부갑상선 기능항진증, 부갑상선 전절제술 및 자가이식술, 만성 신부전증,Secondary hyperparathyroidism, Total parathyroiectomy and autotransplantation, ESRD