Long-Term Intravenous Calcitriol in Secondary Hyperparathyroidism: The Role of Technetium-99m-Mibi Scintigraphy in Predicting the Response to Treatment

Owda, Ali; Mousa, Dujanah; Abdallah, Abdallah H.; Hawas, Fahad; Al-Harbi, Wedad; Fedail, Halima; Al-Shoail, Ghada; Al-Sulaiman, M. H.; Al-Khader, Abdullah A

doi:10.1081/jdi-120004093

Cited by 7 publications

(3 citation statements)

References 13 publications

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“…As a result of pathological changes that occur during parathyroid gland hyperplasia, the utility of current SHPT treatment modalities can be compromised. In severe or refractory SHPT, when parathyroid glands are grossly enlarged or exhibit monoclonal growth patterns, patients can become resistant to vitamin D therapy (24,89,107). This may be the result of a significant reduction in the expression of VDRs that negates the actions of vitamin D sterols.…”

Section: The Car and Management Of Shptmentioning

confidence: 99%

The calcium-sensing receptor: a key factor in the pathogenesis of secondary hyperparathyroidism

Rodriguez¹,

Nemeth²,

Martin³

2005

American Journal of Physiology-Renal Physiology

161

107

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Serum calcium levels are regulated by the action of parathyroid hormone (PTH). Major drivers of PTH hypersecretion and parathyroid cell proliferation are the hypocalcemia and hyperphosphatemia that develop in chronic kidney disease patients with secondary hyperparathyroidism (SHPT) as a result of low calcitriol levels and decreased kidney function. Increased PTH production in response to systemic hypocalcemia is mediated by the calcium-sensing receptor (CaR). Furthermore, as SHPT progresses, reduced expression of CaRs and vitamin D receptors (VDRs) in hyperplastic parathyroid glands may limit the ability of calcium and calcitriol to regulate PTH secretion. Current treatment for SHPT includes the administration of vitamin D sterols and phosphate binders. Treatment with vitamin D is initially effective, but efficacy often wanes with further disease progression. The actions of vitamin D sterols are undermined by reduced expression of VDRs in the parathyroid gland. Furthermore, the calcemic and phosphatemic actions of vitamin D mean that it has the potential to exacerbate abnormal mineral metabolism, resulting in the formation of vascular calcifications. Effective new treatments for SHPT that have a positive impact on mineral metabolism are clearly needed. Recent research shows that drugs that selectively target the CaR, calcimimetics, have the potential to meet these requirements.

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Section: The Car and Management Of Shptmentioning

confidence: 99%

The calcium-sensing receptor: a key factor in the pathogenesis of secondary hyperparathyroidism

Rodriguez¹,

Nemeth²,

Martin³

2005

American Journal of Physiology-Renal Physiology

161

107

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“…It was shown that MIBI-scan could be used to evaluate parathyroid function as well as response to treatment with calcitriol [22, 23]. In our case with positive basal MIBI-scan after the inhibition test with calcitriol (2 μ g i.v.…”

Section: Discussionmentioning

confidence: 79%

Failed Switching off in the MIBI-Parathyroid Scintigraphy in a Dialyzed Patient with Secondary Hyperparathyroidism Responsive to Cinacalcet Therapy

Bolasco

Serra

Loi

et al. 2010

International Journal of Endocrinology

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The aims of your case report is to show the predictivity of 99mTc-sestamibi (MIBI) scintigraphy and doppler ultrasound imaging on secondary hyperparathyroidism (SHPT) in a patient responsive to calcimimetic treatment. Moreover, it has been reported that calcimimetic has great potential in reducing the volume of the parathyroid gland. On the other hand, the MIBI scintigraphy is considered a crucial diagnostic procedure to monitor the response to therapy in terms of turnover and cellular metabolism; whereas, ultrasound to monitor the volume variation in response to treatment. It is described the case of a 73-year-old man on hemodialysis from 1995 for ESRD. Within 2 years the patient gradually developed SHPT with progressively increased iPTH up to 1,000 ρg/ml. The ultrasound, highlighted the presence of two parathyroid hyperplasia, confirmed by scintigraphy, showing focal increase uptake of sestamibi in the same anatomical areas. As a result of the patient's refusal to perform a parathyroidectomy, cinacalcet, was administered (65 mg overage daily dose). After a year of treatment, there was a striking decrease of iPTH (from 1300 to 57 ρg/ml, −95%); but, on the contrary to expectations, this positive metabolic outcome, was not followed by parathyroid changes in ultrasound and scintigraphic findings.

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“…Imaging of the parathyroid glands has been used in the identification of solitary parathyroid adenomas, which is the most common finding in patients with primary HPT [1]. parathyroid scintigraphy [3][4][5][6][7][8][9][10][11][12][13][14][15][16] and ultrasound (US) [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32], have been assayed to establish their possible utility in SHP. Recently, preoperative non-invasive imaging tools, i.e.…”

Section: Introductionmentioning

confidence: 99%

Role of Preoperative Diagnostic Imaging Procedures in Secondary Hyperparathyroidism

Fuster¹,

Ybarra²,

Torregrosa³

et al. 2005

CMIR

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Parathyroid imaging has been widely used for the identification and localization of abnormal parathyroid adenomas in patients with suspected primary hyperparathyroidism and for preoperative and reoperative localization. However, recently developed methods of functional imaging, like 99mTc-sestamibi parathyroid scan combined with routine anatomic procedures, provide additional quantitative and qualitative information on various types and stages of parathyroid hyperplasia which is the common presentation of secondary hyperparathyroidism. This kind of information could not only prove useful in preoperative diagnosis, but also in the selection of medical or surgical therapeutic alternatives in secondary hyperparathyroidism patients. Our group found a significant correlation between 99mTcsestamibi uptake and parathormone blood levels but no correlation was found with other determinants of hyperparathyroidism. This finding demonstrates that scintigraphy accurately reflects the gland activity independently from other biochemical parameters that could be influencing gland secretion. It is reasonable to assume that better preoperative information will ease the detection of hyperplastic glands and reduce operative time and surgical trauma. This review discusses the role of non-invasive imaging modalities prior to surgery, and also in the clinical management of patients with secondary hyperparathyroidism.

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Long-Term Intravenous Calcitriol in Secondary Hyperparathyroidism: The Role of Technetium-99m-Mibi Scintigraphy in Predicting the Response to Treatment

Abstract: We conclude that MIBI scan is a reliable technique in predicting the response to treatment with i.v. calcitriol in patients with secondary hyperparathyroidism.

Cited by 7 publications

References 13 publications

The calcium-sensing receptor: a key factor in the pathogenesis of secondary hyperparathyroidism

The calcium-sensing receptor: a key factor in the pathogenesis of secondary hyperparathyroidism

Failed Switching off in the MIBI-Parathyroid Scintigraphy in a Dialyzed Patient with Secondary Hyperparathyroidism Responsive to Cinacalcet Therapy

Role of Preoperative Diagnostic Imaging Procedures in Secondary Hyperparathyroidism

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