Clinical Use of Cinacalcet in MEN1 Hyperparathyroidism

Abstract EN

Background.

Management of multiple-endocrine neoplasia type 1- (MEN1-) associated hyperparathyroidism is associated with high recurrence rates and high surgical morbidity due to multiple neck explorations.

Cinacalcet, a calcimimetic agent licensed for the treatment of secondary hyperparathyroidism and parathyroid carcinoma, may provide a medical alternative for the management of these complex patients.

Methods.

A prospective audit was performed of eight patients; three males and five females, aged 20–38 at diagnosis.

Two patients commenced cinacalcet as primary treatment and six had previous surgery.

Six patients had complications of hyperparathyroidism: renal calculi, renal dysfunction, and reduced bone mineral density.

All were commenced on cinacalcet 30 mg bd for MEN1 associated hyperparathyroidism; doses were subsequently reduced to 30 mg od in four patients.

Results.

Significant reductions were observed in serum calcium and PTH measurements.

Serum calcium reduced by a median of 0.35 mmol/L (P=.012 Wilcoxon Signed Rank).

Serum PTH levels decreased by a median of 5.05 pmol/L (P=.012).

There was no change in urine calcium.

Duration ranged from 10–35 months with maintenance of control.

Cinacalcet was well tolerated by six patients; one experienced nausea and one experienced diarrhoea.

Conclusion.

Cinacalcet is an effective and well-tolerated medical treatment for the management of complex primary hyperparathyroidism.