Successful use of cinacalcet HCl in a patient with end-stage renal failure and refractory secondary hyperparathyroidism due to parathyromatosis.
We present the case of a 65-year-old male on long-term dialysis for end-stage renal failure, who developed persistent secondary hyperparathyroidism after subtotal parathyroidectomy, which proved refractory to treatment. Parathyromatosis, a rare cause of recurrent hyperparathyroidism, which may develop when tissue seeded into the neck during subtotal or total parathyroidectomy becomes hyperfunctioning [Maxwell and Winearls 1997], was diagnosed. The patient had excessively high levels of circulating parathyroid hormone (PTH), elevated serum calcium and deteriorating cardiovascular status. Repeated surgery and treatment with high-dose vitamin D failed to provide a sustained decrease in serum PTH levels. Administration of cinacalcet HCl, a second generation calcimimetic, at doses of 30 - 180 mg/day provided a gradual and sustained suppression of PTH (> 1,700 - 344 ng/l) without increasing the calcium-phosphate product.
Unbehaun
R
R
Nephrologische Gemeinschaftspraxis, Gera, Germany. rolf.wolf@gmx.de
Lauerwald
W
W
D000368:Aged; D002118:Calcium / Q000097:blood; D002828:Choristoma / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D000069449:Cinacalcet; D005500:Follow-Up Studies; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D007676:Kidney Failure, Chronic / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D009281:Naphthalenes / Q000627:therapeutic use*; D010280:Parathyroid Glands; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy / Q000009:adverse effects / Q000379:methods; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012086:Reoperation; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi; D020775:Thoracic Surgery, Video-Assisted; D013959:Thyroid Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D014057:Tomography, X-Ray Computed
D009281:Naphthalenes; D010281:Parathyroid Hormone; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D002118:Calcium; D000069449:Cinacalcet