The Journal of clinical endocrinology and metabolism · 2017
Thiazide Treatment in Primary Hyperparathyroidism-A New Indication for an Old Medication?
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Tsvetov Gloria, Hirsch Dania, Shimon Ilan, Benbassat Carlos, Masri-Iraqi Hiba, Gorshtein Alexander, Herzberg Dana, Shochat Tzippy, Shraga-Slutzky Ilana, Diker-Cohen Talia
Аннотация
CONTEXT: There is no therapy for control of hypercalciuria in nonoperable patients with primary hyperparathyroidism (PHPT). Thiazides are used for idiopathic hypercalciuria but are avoided in PHPT to prevent exacerbating hypercalcemia. Nevertheless, several reports suggested that thiazides may be safe in patients with PHPT.
OBJECTIVE: To test the safety and efficacy of thiazides in PHPT.
DESIGN: Retrospective analysis of medical records.
SETTING: Endocrine clinic at a tertiary hospital.
PATIENTS: Fourteen male and 58 female patients with PHPT treated with thiazides.
INTERVENTIONS: Data were compared for each patient before and after thiazide administration.
MAIN OUTCOME MEASURES: Effect of thiazide on urine and serum calcium levels.
RESULTS: Data are given as mean ± standard deviation. Treatment with hydrochlorothiazide 12.5 to 50 mg/d led to a decrease in mean levels of urine calcium (427 ± 174 mg/d to 251 ± 114 mg/d; P < 0.001) and parathyroid hormone (115 ± 57 ng/L to 74 ± 36 ng/L; P < 0.001), with no change in serum calcium level (10.7 ± 0.4 mg/dL off treatment, 10.5 ± 1.2 mg/dL on treatment, P = 0.4). Findings were consistent over all doses, with no difference in the extent of reduction in urine calcium level or change in serum calcium level by thiazide dose.
CONCLUSION: Thiazides may be effective even at a dose of 12.5 mg/d and safe at doses of up to 50 mg/d for controlling hypercalciuria in patients with PHPT and may have an advantage in decreasing serum parathyroid hormone level. However, careful monitoring for hypercalcemia is required.
OBJECTIVE: To test the safety and efficacy of thiazides in PHPT.
DESIGN: Retrospective analysis of medical records.
SETTING: Endocrine clinic at a tertiary hospital.
PATIENTS: Fourteen male and 58 female patients with PHPT treated with thiazides.
INTERVENTIONS: Data were compared for each patient before and after thiazide administration.
MAIN OUTCOME MEASURES: Effect of thiazide on urine and serum calcium levels.
RESULTS: Data are given as mean ± standard deviation. Treatment with hydrochlorothiazide 12.5 to 50 mg/d led to a decrease in mean levels of urine calcium (427 ± 174 mg/d to 251 ± 114 mg/d; P < 0.001) and parathyroid hormone (115 ± 57 ng/L to 74 ± 36 ng/L; P < 0.001), with no change in serum calcium level (10.7 ± 0.4 mg/dL off treatment, 10.5 ± 1.2 mg/dL on treatment, P = 0.4). Findings were consistent over all doses, with no difference in the extent of reduction in urine calcium level or change in serum calcium level by thiazide dose.
CONCLUSION: Thiazides may be effective even at a dose of 12.5 mg/d and safe at doses of up to 50 mg/d for controlling hypercalciuria in patients with PHPT and may have an advantage in decreasing serum parathyroid hormone level. However, careful monitoring for hypercalcemia is required.