title: Restoration of reversed whole PTH/intact PTH ratio and reduction in parathyroid gland vascularity during cinacalcet therapy for severe hyperparathyroidism in a uraemic patient.
abstract: Parathyroid hormone (PTH) levels measured with the intact PTH assays are generally higher than those measured with the whole PTH assay; however, rare exceptions to this rule have been reported in patients with severe hyperparathyroidism associated with N-PTH overproduction. We report a haemodialysis patient with severe secondary hyperparathyroidism, in whom abnormally higher whole PTH levels than intact PTH levels were normalized during cinacalcet therapy. Moreover, we observed a marked reduction in parathyroid gland vascularity during this treatment. Our findings suggested that increased sensitivity of the parathyroid calcium sensing receptor by calcimimetics may modulate the secretion or truncation of N-PTH or other PTH molecules that can be detected by the whole PTH assay but not by the intact PTH assays.
authors.affiliation: Division of Nephrology and Kidney Center, Kobe University School of Medicine, Kobe 650-0017, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Komaba
authors.forename: Jeongsoo
authors.initials: J
authors.lastname: Shin
authors.forename: Masafumi
authors.initials: M
authors.lastname: Fukagawa
mesh_terms: D000069449:Cinacalcet; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood* / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000494:pharmacology / Q000627:therapeutic use*; D010280:Parathyroid Glands / Q000098:blood supply* / Q000187:drug effects*; D010281:Parathyroid Hormone / Q000097:blood*; D012720:Severity of Illness Index; D014511:Uremia / Q000097:blood / Q000150:complications
chemical_list: D009281:Naphthalenes; D010281:Parathyroid Hormone; D000069449:Cinacalcet