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Int J Endocrinol. 2010;2010:906163. doi: 10.1155/2010/906163. Epub 2010 May 26.

Clinical Use of Cinacalcet in MEN1 Hyperparathyroidism.

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1
Department of Endocrinology, St. Bartholomew's Hospital, London EC1A 7BE, UK.

Abstract

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.

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