Aminopropylidine Diphosphonate (Apd) in Mild Primary Hyperparathyroidism: Effect on Clinical Status

Abstract

Mild hypercalcaemia associated with primary hyperparathyroidism has been increasingly recognized with the use of automated biochemical screening. Management is often difficult as symptoms are often absent or non-specific. Accordingly, we employed the hypocalcaemic effect of the diphosphonate APD to assess the effect of an acute fall in plasma calcium on indices of general well being, blood pressure, and vasoactive hormones in patients with mild primary hyperparathyroidism. Ten patients were studied in a randomized single blind, placebo-controlled cross-over study, using 30 mg APD intravenously or control saline infusion, over 2 h. Metabolic measurements, formal tests of muscle strength and cognitive function, and a standardized questionnaire were assessed 7 days after infusions. Albumin corrected plasma calcium was significantly lower (mean 2.49 +/- 0.04 SEM mmol/l) after APD when compared to control values (2.70 +/- 0.06 mmol/l, P less than 0.001). Twenty-four-hour urinary calcium, plasma magnesium and absolute monocyte count decreased significantly, whereas plasma parathyroid hormone increased after APD (P less than 0.05). There was no significant change in hypercalcaemic symptoms, muscle strength or cognitive function, and blood pressure, renin, aldosterone and atrial natriuretic peptide did not change. Side-effects, when they occurred, were mild. It is concluded that APD is a safe and effective means of lowering plasma calcium in mild primary hyperparathyroidism, but these acute reductions are associated with little or no improvement in clinical status in these patients.

A Strategy for the Management of Elderly Women with Primary Hyperparathyroidism: A Comparison of Etidronate Therapy with Parathyroidectomy

“…In contrast, untreated postmenopausal women with PHPT have a low BMD resulting from accelerated bone loss [4]. Treatment with bisphosphonate has been successful in ameliorating hypercalcemia and parathyroid hormone (PTH) induced high bone resorption [5][6][7][8][9][10][11][12]. Intravenous disodium pamidronate has been used to treat PHPT patients in whom there was surgical failure or reoperation, or who are aged and in a fragile condition.…”

Contemporary Medical Management of Primary Hyperparathyroidism: A Systematic Review

“…The distribution of studies included in the meta-regression was as follows: 7 pamidronate, 9 alendronate, 3 clodronate, 1 etidronate, 1 risedronate, 3 mixed bisphosphonates, and 16 cinacalcet. Six of these studies provided data by means of graphs and figures (16, 18, 28, 30, 32, 56) and two (17, 58) reported only in terms of range, and values therefore were acquired as previously described.…”

Decrease of serum calcium concentration and lost influence of calcium on parathyroid hormone release in a patient with primary hyperparathyroidism after treatment with diphosphonates

“…Schmidli et al [27] observed no significant changes in the clinical status of patients receiving pamidronate as treatment for severe hypercalcemia, suggesting that any changes in the clinical status would occur only after a long lasting normalization of serum Ca. However, in our patient who presented with generalized muscle weakness, collapses, memory impairment, and depression, we could observe an impressive improvement of mental function and muscle strength after therapy with diphosphonates.…”