Parathyroid Apoplexy Following Cinacalcet Treatment in Primary Hyperparathyroidism

Abstract

Cinacalcet, a calcimimetic drug, is considered a safe and valid option for the treatment of hypercalcemia in patients with primary hyperparathyroidism who are unable to undergo parathyroidectomy. Hypocalcemia and gastrointestinal adverse reactions are the main side effects reported in patients treated with cinacalcet. We present here the case of an 80-years-old patient with primary hyperparathyroidism treated with cinacalcet for 17 months who developed a severe and symptomatic episode of hypocalcemia requiring hospitalization 1 month after reaching a daily dose of 180 mg. Follow-up laboratory and imaging exams showed remission of primary hyperparathyroidism and disappearance of the parathyroid adenoma, suggesting a possible association between cinacalcet therapy and parathyroid infarction resulting in normalization of the elevated serum parathyroid hormone levels and severe hypocalcemia. No known cases of iatrogenic parathyroid apoplexy have thus far been described. We report here the first case of parathyroid apoplexy associated with the administration of cinacalcet in a patient with primary hyperparathyroidism. Parathyroid apoplexy features heterogeneous clinical manifestations ranging from relatively asymptomatic to potentially life-threatening cases. The occurrence of this complication should be carefully considered in patients with primary hyperparathyroidism in therapy with cinacalcet.

Severe Symptomatic Hypocalcemia, complicating cardiac arrhythmia following Cinacalcet (SensiparTM) administration: A Case Report

“…Since this episode, he has no recurrences of arrhythmias. Dalmazi et al 16 reported a patient with primary hyperparathyroidism developing severe hypocalcemia, related to parathyroid adenoma infarction apparently due to cinacalcet administration. In our patient, the gradual onset of hypocalcemia, the follow‐up ultrasound findings, and complete recovery when cinacalcet was discontinued strongly suggest the hypocalcemia was not related to parathyroid infarction.…”

Cinacalcet-Associated Resolution of Primary Hyperparathyroidism in a Patient With Normal Kidney Function

“…On the other hand, the fact that we were able to wean the patient off the calcium supplementation without use of active vitamin D analogs after 2.5 years from the episode of hypocal cemia suggests that the patient may have initially had dormant fifth parathyroid gland that became functionally active once the activity of 4 parathyroid glands has ceased due to surgical excision and cinacalcet exposure. In a previous case report, Di Dalmazi et al 10 described an 80yearold patient with PHPT treated with cinacalcet for 17 months at a maximum dose of 180 mg daily who developed severe and symptomatic hypo calcemia that was associated with the resolution large parathy roid adenoma. In contrast, our patient has been receiving only a very small dose of cinacalcet for a short period of time and did not have clear radiographic evidence of parathyroid adenoma(s).…”

Parathyroid Glands and Hyperparathyroidism: A General Overview

“…However, in symptomatic cases with evidence of bone and kidney disease, surgical treatment is preferred [27,31,32,42]. Treatment with bisphosphonates and calcimimetics, such as cinacalcete, is applied in cases of severe hypercalcemia and difficulty in performing surgical treatment in a timely manner [43,44]. Therapeutic doubt arises in asymptomatic cases, in which initial surgical treatment is often not Parathyroid Glands and Hyperparathyroidism: A General Overview DOI: http://dx.doi.org /10.5772/intechopen.92785 indicated.…”