title: The effect of cinacalcet on intraoperative findings in tertiary hyperparathyroidism patients undergoing parathyroidectomy.
abstract: BACKGROUND
  Tertiary hyperparathyroidism (3HPTH) patients who undergo parathyroidectomy (PTX) are often managed with calcium lowering medications such as cinacalcet (Sensipar) before surgery. Here, we assess how cinacalcet treatment influences intraoperative parathyroid hormone (IOPTH) kinetics and surgical findings in 3HPTH patients undergoing PTX.
  
  
  METHODS
  We reviewed retrospectively 113 patients 3HPTH who underwent PTX, 14 of whom were taking cinacalcet and 112 who were not taking the drug. IOPTH levels fitted to linear curves versus time were used to evaluate the role of cinacalcet.
  
  
  RESULTS
  Cinacalcet did not correlate with rates of cure (P = .41) or recurrence (P = .54). Patients taking cinacalcet experienced a steeper decrease in IOPTH compared with those not taking the medication (P = .005). Cinacalcet treatment was associated with an increase in rate of hungry bones (P = .04). Weights of the heaviest glands resected (P = .02) and preoperative PTH levels (P = .0004) were greater among patients taking cinacalcet.
  
  
  CONCLUSIONS
  Perioperative cinacalcet treatment in patients with 3HPTH alters IOPTH kinetics by causing a steeper decrease in IOPTH, but does not require modification of the standard IOPTH protocol. Although cinacalcet use does not adversely affect cure rates, it is associated with greater preoperative PTH and an increased incidence of hungry bones, hence serving as an indicator of more severe disease. Cinacalcet does not need to be held before operation.
authors.affiliation: Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: Yash R
authors.initials: YR
authors.lastname: Somnay
authors.affiliation: Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: Eric
authors.initials: E
authors.lastname: Weinlander
authors.affiliation: Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: David F
authors.initials: DF
authors.lastname: Schneider
authors.affiliation: Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Sippel
authors.affiliation: Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, University of Wisconsin, Madison, WI. Electronic address: chen@surgery.wisc.edu.
authors.forename: Herbert
authors.initials: H
authors.lastname: Chen
mesh_terms: D000328:Adult; D000069449:Cinacalcet; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D009281:Naphthalenes / Q000627:therapeutic use*; D010281:Parathyroid Hormone / Q000032:analysis*; D016105:Parathyroidectomy / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D012016:Reference Values; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D009281:Naphthalenes; D010281:Parathyroid Hormone; D000069449:Cinacalcet