title: Tertiary hyperparathyroidism resistant to cinacalcet treatment.
abstract: Cinacalcet hydrochloride (cinacalcet) has been reported to be efficacious for patients with tertiary hyperparathyroidism (THPT). We experienced five patients with THPT requiring parathyroidectomy (PTx) because of resistance to cinacalcet treatment and investigated their clinical characteristics and clinical course. The maximum diameter of the parathyroid gland estimated by ultrasonography before renal transplantation was evaluated. Serum total calcium, phosphorus, intact parathyroid hormone (iPTH), alkaline phosphatase (ALP), and creatinine (Cr) levels were investigated every three months after the administration of cinacalcet and at PTx. After surgery, the Cr levels were followed. In all five patients, at least one parathyroid gland had a largest diameter of more than 1 cm, and the mean diameter was 18.7 mm (range 14.9-24.1 mm). Intact PTH and ALP levels gradually increased after the initiation of cinacalcet and the Cr levels transiently increased after PTx. These findings suggest that the existence of a severely enlarged nodular hyperplastic gland is a main factor involved in resistance to cinacalcet.
authors: Department of Transplantation and Endocrine Surgery, Nagoya Second Red Cross Hospital, Showa-ku, Nagoya, Japan.
authors: Manabu
authors: M
authors: Okada
authors: Yoshihiro
authors: Y
authors: Tominaga
authors: Kumiko
authors: K
authors: Izumi
authors: Hironobu
authors: H
authors: Nobata
authors: Takayuki
authors: T
authors: Yamamoto
authors: Takahisa
authors: T
authors: Hiramitsu
authors: Makoto
authors: M
authors: Tsujita
authors: Norihiko
authors: N
authors: Goto
authors: Koji
authors: K
authors: Nanmoku
authors: Toshihiko
authors: T
authors: Watarai
authors: Kazuharu
authors: K
authors: Uchida