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Tertiary Hyperparathyroidism Resistant to Cinacalcet Treatment
Author(s) -
Okada Manabu,
Tominaga Yoshihiro,
Izumi Kumiko,
Nobata Hironobu,
Yamamoto Takayuki,
Hiramitsu Takahisa,
Tsujita Makoto,
Goto Norihiko,
Nanmoku Koji,
Watarai Toshihiko,
Uchida Kazuharu
Publication year - 2011
Publication title -
therapeutic apheresis and dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.415
H-Index - 53
eISSN - 1744-9987
pISSN - 1744-9979
DOI - 10.1111/j.1744-9987.2011.00924.x
Subject(s) - cinacalcet , medicine , tertiary hyperparathyroidism , parathyroidectomy , parathyroid hormone , hyperparathyroidism , urology , secondary hyperparathyroidism , parathyroid gland , creatinine , endocrinology , calcium
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.