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Tierarztl Prax Ausg K Kleintiere Heimtiere 2017; 45(02): 122-133
DOI: 10.15654/TPK-160923
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Diagnostische Aufarbeitung und Management der Hyperkalzämie des Hundes am Beispiel des primären Hyperparathyreoidismus

Diagnostic approach and management of hypercalcaemia in dogs exemplary of primary hyperparathyroidism
B. Désirée Ballhausen
1   Medizinische Kleintierklinik, Ludwig-Maximilians-Universität München
,
Astrid Wehner
1   Medizinische Kleintierklinik, Ludwig-Maximilians-Universität München
,
Martin Zöllner
2   Chirurgische und Gynäkologische Kleintierklinik, Ludwig-Maximilians-Universität München
,
Katrin Hartmann
1   Medizinische Kleintierklinik, Ludwig-Maximilians-Universität München
,
Stefan Unterer
1   Medizinische Kleintierklinik, Ludwig-Maximilians-Universität München
› Author Affiliations
Further Information

Publication History

Eingegangen: 19 October 2016

Akzeptiert nach Revision: 22 February 2017

Publication Date:
08 January 2018 (online)

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Zusammenfassung

Eine Hyperkalzämie kann Folge diverser Erkrankungen sein. Der Artikel erläutert die Ursachen, die pathophysiologischen Zusammenhänge sowie die diagnostische Abklärung und gibt Empfehlungen für die Behandlung. Im Vordergund steht dabei die Hyperkalzämie im Rahmen eines primären Hyperparathyreoidismus (PH), ergänzt durch ein entsprechendes Fallbeispiel. Eine erhöhte Gesamtkalzium-Konzentration sollte grundsätzlich abgeklärt und durch Messung der Konzentration von ionisiertem Kalzium verifiziert werden. Die weitere diagnostische Aufarbeitung richtet sich nach der Höhe der Phosphatkonzentration. Gegebenenfalls sind ein Tumorscreening, die Messung von Parathormon und Parathormon-ähnlichem Protein sowie eine sonographische Untersuchung der Nebenschilddrüsen erforderlich. Überschreitet das Kalzium-Phosphat-Produkt (Werte in mg/dl) den Wert 60, besteht die Gefahr der Mineralisation von Geweben und eine schnelle Behandlung ist wichtig. Zur Akutbehandlung können Infusionen physiologischer Kochsalzlösung, Furosemid und Glukokortikoide eingesetzt werden. Glukokortikoide sollten jedoch nur nach strenger Indikation und bereits gestellter Diagnose verwendet werden. Beim Langzeitmanagement kommen zunehmend Bisphosphonate, insbesondere Alendronat, erfolgreich zur Anwendung. Die kausale Therapie des PH erfolgt mittels Parathyreoidektomie, Hitzeablation oder Ethanolablation. Im Anschluss kann, insbesondere bei ausgeprägter präoperativer Hyperkalzämie, eine Hypokalzämie auftreten. Zur Behandlung wird Vitamin D3 (Calcitriol) verabreicht (bei starker Hyperkalzämie gegebenenfalls bereits präoperativ zur Prophylaxe). Eine begleitende orale Kalziumsupplementation mit Kalziumkarbonat als Mittel der Wahl wird kontrovers diskutiert. Aufgrund der Rezidivgefahr nach erfolgreicher Entfernung der bei einem PH betroffenen Nebenschilddrüse sollte der Serumkalziumspiegel periodisch kontrolliert werden.

Summary

Hypercalcaemia can be caused by many different diseases. This article summarizes the causes, pathophysiologic mechanisms and diagnostic procedures as well as treatment recommendations. The main focus is on hypercalcaemia in primary hyperparathyroidism (PH), complemented by a case report. An elevated total calcium level should general ly be investigated and verified by measurement of ionized calcium concentration. The further diagnostic approach depends on the phosphate level. Tumour screening, measurement of parathormone and parathromone-related protein and sonography of parathyroid glands may be necessary. If the calcium-phosphate-product exceeds 60 mg/dl, there is a risk of tissue mineralisation and a rapid treatment of hypercalcaemia is required. For acute therapy, sodium chloride infusion, furosemide and glucocorticoids can be used. Glucocorticoids should only be given after strict indication and after a definite diagnosis. For long-term management, bisphosphates, particularly alendronate, are increasingly used successfully. Causal therapy of PH can be performed by parathyreoidectomy, heat ablation or ethanol abla tion. Thereafter, particularly in cases of severe preoperative hypercalcaemia, hypocalcaemia can occur. Treatment is performed using vitamin D3 (calcitriol), which may also be given preoperatively in cases of severe hypercalcaemia. A concomitant oral calcium supplementation using calcium carbonate as medication of choice is contentious. Due to a potential relapse after successful excision of the affected parathyroid gland in PH, the serum calcium level should be monitored perio dically.

Schlüsselwörter

Kalzium - Nebenschilddrüse - kanin - Parathormon - PTH

Keywords

Calcium - parathyroid gland - canine - parathormone - PTH
 

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