title: Therapeutic challenges in elderly patients with symptomatic hypercalcaemia caused by primary hyperparathyroidism.
abstract: BACKGROUND
  Hypercalcaemia resulting from primary hyperparathyroidism (PHPT) can cause a wide range of symptoms, including cognitive disorders, psychiatric symptoms and muscle weakness. Parathyroid surgery is the only definite cure for PHPT. When surgery is contraindicated or patients decide against it, several non-surgical treatment options are available.
  
  
  OBJECTIVE
  To illustrate the treatment options of symptomatic hypercalcaemia caused by PHPT in the elderly and discuss these options in consideration of the available evidence.
  
  
  METHODS
  Consecutive case series.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Four older patients aged 79-87 years with symptomatic hypercalcaemia resulting from PHPT.
  
  
  RESULTS
  Three patients had a parathyroid adenoma shown on a sestamibi scan. Normocalcaemia and resolution of symptoms was achieved by different treatment scenarios encompassing forced saline hydration, forced diuresis, intravenous pamidronate and cinacalcet, a calcimimetic drug. In one patient, no parathyroid abnormalities were revealed with imaging. Treatment with cinacalcet resulted in normocalcaemia and a strong improvement of symptoms.
  
  
  CONCLUSIONS
  In clinical practice, different treatment scenarios are chosen for the treatment of elderly patients with symptomatic hypercalcaemia caused by PHPT. The introduction of cinacalcet offers a new treatment paradigm. We propose to apply cinacalcet preceding elective surgery as an alternative option to standard therapy or as maintenance dose when surgery is not possible.
authors.affiliation: Department of Internal Medicine, St Antonius Hospital Nieuwegein, Nieuwegein, the Netherlands. l.jacobs@antoniusziekenhuis.nl
authors.forename: L
authors.initials: L
authors.lastname: Jacobs
authors.forename: M M
authors.initials: MM
authors.lastname: Samson
authors.forename: H J J
authors.initials: HJ
authors.lastname: Verhaar
authors.forename: H L
authors.initials: HL
authors.lastname: Koek
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D057966:Calcimimetic Agents / Q000627:therapeutic use*; D000069449:Cinacalcet; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D049950:Hyperparathyroidism, Primary / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D009281:Naphthalenes / Q000627:therapeutic use*
chemical_list: D057966:Calcimimetic Agents; D009281:Naphthalenes; D000069449:Cinacalcet