title: Successful use of bisphosphonate and calcimimetic in neonatal severe primary hyperparathyroidism.
abstract: Neonatal primary hyperparathyroidism (NPHT) is associated with an inactivating homozygous mutation of the calcium sensing receptor (CaSR). The CaSR is expressed most abundantly in the parathyroid glands and the kidney and regulates calcium homeostasis through its ability to modulate parathormone secretion and renal calcium reabsorption. NPHT leads to life threatening hypercalcemia, nephrocalcinosis, bone demineralization, and neurologic disabilities. Surgery is the treatment of choice. While waiting for surgery, bisphosphonates offer a good alternative to deal with hypercalcemia. Cinacalcet is a class II calcimimetic that increases CaSR affinity for calcium, leading to parathormone suppression and increased calcium renal excretion. At present, there is little evidence as to whether cinacalcet could improve the function of mutant CaSR in NPHT. We report a case of NPHT, treated successfully with bisphosphonates and cinacalcet after surgery failure. To our knowledge, it is the first time cinacalcet has been used for NPHT.
authors.affiliation: Division of Pediatric Nephrology, Department of Pediatrics, Children Hospital, Geneva, Switzerland. alexandra.wilhelm-bals@hcuge.ch
authors.forename: Alexandra
authors.initials: A
authors.lastname: Wilhelm-Bals
authors.forename: Paloma
authors.initials: P
authors.lastname: Parvex
authors.forename: Corinne
authors.initials: C
authors.lastname: Magdelaine
authors.forename: Eric
authors.initials: E
authors.lastname: Girardin
mesh_terms: D002118:Calcium / Q000378:metabolism; D000069449:Cinacalcet; D003131:Combined Modality Therapy; D004164:Diphosphonates / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics / Q000601:surgery*; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009281:Naphthalenes / Q000008:administration & dosage*; D016105:Parathyroidectomy / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D004164:Diphosphonates; D009281:Naphthalenes; D002118:Calcium; D000069449:Cinacalcet