Ivica Lazúrová
Primary hyperparathyreosis is the most frequent cause of hypercalcaemia in out-patients. Majority of patients is asymptomatic but the part of them can have symptoms which are the result of parathormone (PTH) activity on various organs and systems. Although parathyreoidectomy is the only curable treatment of PHPT, but in some patients it can fail or could be highly risky or even contraindicated. In these cases pharmacologic treatment is necessary. Medicaments which are used in the therapy of PHPT can be divided into two groups: the first group is created by medicaments affecting the target organs PTH (estrogens, bisphosphonates, calcitonin and others) and calcimimetics - medicaments acting directly on secretion of PTH - create the second group. Their main representative is cinacalcet. In several studies cinacalcet had a distinctive effect on calcium level normalization and this effect persists also during long-term application. It is well tolerated and represents the quality and effective treatment of primary hyperparathyreosis. Other therapeutical options involve monoclonal antigens against PTH or a PTH receptor and other new agonists or allosteric modulators CaR.