title: Clinical utilization of cinacalcet in hypercalcemic conditions.
abstract: BACKGROUND
  Cinacalcet has recently been introduced as a treatment for secondary hyperparathyroidism in dialysis patients and for parathyroid carcinoma. However, there has been an increasing interest in finding out whether cinacalcet can be used as a treatment for other parathyroid hormone (PTH)-dependent hypercalcemic conditions also.
  
  
  METHODS
  The article reports the most relevant recent contributions dealing with calcium sensing receptor (CaSR) physiology as well as cinacalcet pharmacokinetics and pharmacodynamics. It also looks at the different hypercalcemic conditions where the use of cinacalcet has been proposed. This article was researched using clinical trials, case reports and outstanding basic research published in the last 3 years (MEDLINE database up to 31 November 2010). It provides the reader with an insight into the many unaddressed issues regarding cinacalcet that need to be resolved before it can be used in newly proposed fields.
  
  
  CONCLUSIONS
  Since cinacalcet may not only have an effect on parathyroid CaSR but also on CaSR expressed at bone and renal levels, it can currently only be considered a good alternative to parathyroidectomy in PTH-dependent hypercalcemic conditions when surgical intervention is burdened by a high failure rate or when it can be considered a risky procedure. At present, cinacalcet cannot be considered the first choice treatment in asymptomatic primary hyperparathyroidism or in mild-to-moderate forms of familial hypocalciuric hypocalcemia.
authors.affiliation: Division of Nephrology, Dialysis, and Renal Transplant, Fondazione Ca' Granda-IRCCS, OspedaleMaggiore-Policlinico, v. Commenda 15, 20122 Milano, Italy. pmessa@policlinico.mi.it
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Messa
authors.forename: Carlo
authors.initials: C
authors.lastname: Alfieri
authors.forename: Brigida
authors.initials: B
authors.lastname: Brezzi
mesh_terms: D057966:Calcimimetic Agents / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D000069449:Cinacalcet; D002986:Clinical Trials as Topic; D004341:Drug Evaluation; D006801:Humans; D006934:Hypercalcemia / Q000188:drug therapy*; D049950:Hyperparathyroidism, Primary / Q000188:drug therapy; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy; D016030:Kidney Transplantation; D009281:Naphthalenes / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D010281:Parathyroid Hormone / Q000009:adverse effects; D010282:Parathyroid Neoplasms / Q000188:drug therapy; D016105:Parathyroidectomy; D044169:Receptors, Calcium-Sensing / Q000378:metabolism; D006435:Renal Dialysis
chemical_list: D057966:Calcimimetic Agents; D009281:Naphthalenes; D010281:Parathyroid Hormone; D044169:Receptors, Calcium-Sensing; D000069449:Cinacalcet