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Allgemein- und Viszeralchirurgie up2date 2016; 10(02): 73-85
DOI: 10.1055/s-0041-106361
Endokrine Chirurgie
Georg Thieme Verlag KG Stuttgart · New York

Sekundärer Hyperparathyreoidismus

C. Dotzenrath
HELIOS Klinikum Wuppertal
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Publication Date:
13 April 2016 (online)

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Der renale Hyperparathyreoidismus (rHPT) ist eine häufige Komplikation der chronischen Niereninsuffizienz. Die weltweit steigende Zahl der Dialysepatienten verbunden mit einer längeren Lebenserwartung hat die Therapie des rHPT zunehmend zu einem relevanten medizinischen und sozioökonomischen Problem gemacht. Die Therapie wird kontrovers diskutiert: Unstrittig ist die Nierentransplantation (NTP) als die einzige Kausaltherapie. Der Einsatz neuer Therapeutika (kalzium- und aluminiumfreie Phosphatbinder, das Kalzimimetikum Cinacalcet und aktive Vitamin-D3-Analoga haben zu einem deutlichen Rückgang der Nebenschilddrüsenoperationen geführt. Bei Patienten, die trotz medikamentöser Therapie einen schweren biochemischen Hyperparathyreoidismus mit klinischen Symptomen zeigen, z. B. schwere renale Osteopathie, Frakturen, Weichteil- oder Gefäßverkalkungen oder Kalziphylaxie, ist die Operation meistens die einzige therapeutische Option. Mehrere Operationsverfahren werden angewandt. Allerdings sind Persistenz- und Rezidivraten hoch, was zum Teil auch auf den natürlichen Verlauf der Erkrankung zurückzuführen ist.

 

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