Vol 68, No 3 (2017)
Original paper
Published online: 2017-06-21

open access

Page views 2079
Article views/downloads 2061
Get Citation

Connect on Social Media

Connect on Social Media

Cinacalcet as symptomatic treatment of hypercalcaemia in primary hyperparathyroidism prior to surgery

Waldemar Misiorowski1, Wojciech Zgliczyński1
Pubmed: 28660989
Endokrynol Pol 2017;68(3):306-310.


Intriduction: The aim of presented study was to assess the efficacy of cinacalcet in reducing serum calcium concentrations in primary hyperparathyroid (PHPT) patients with hypercalcaemia exceeding 12.5 mg/dL, awaiting parathyroidectomy.

Material and methods: The study included 23 patients with PHPT with hypercalcaemia > 12.5 mg/dL, qualified for surgery. We recorded clinical and biochemical data at baseline, and after every week of treatment. We also monitored adverse events. Cinacalcet was adminis­tered in increasing doses until the corrected serum calcium concentration was 11.3 mg/dL or less, the patient reached the highest possible dosage of 90 mg four times daily, or the patient experienced an adverse event that precluded further dosage increases.

Results: The primary end point of reduction in corrected serum calcium concentration to 11.3 mg/dL was achieved in 19 patients (83%), and normocalcaemia (S-Ca < 10.3 mg/dL) was achieved in 55% of patients. The medication was usually well tolerated (83.4%). Most common adverse events were nausea and vomiting, especially at the beginning of therapy; however, only one patient withdrew from the study because of adverse events.

Conclusion: Cinacalcet rapidly reduced serum calcium in PHPT patients with severe hypercalcaemia and can be useful as a short-term pretreatment prior to surgery, allowing the completion of diagnostics and safe awaiting for operation.


  1. Eastell R, Brandi ML, Costa AG, et al. Diagnosis of asymptomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop. J Clin Endocrinol Metab. 2014; 99(10): 3570–3579.
  2. Bilezikian JP, Brandi ML, Eastell R, et al. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. J Clin Endocrinol Metab. 2014; 99(10): 3561–3569.
  3. Wermers RA, Khosla S, Atkinson EJ, et al. Survival after the diagnosis of hyperparathyroidism: a population-based study. Am J Med. 1998; 104(2): 115–122.
  4. Van Udelsman B, Udelsman R. Surgery in primary hyperparathyroidism: extensive personal experience. J Clin Densitom. 2013; 16(1): 54–59.
  5. Marcocci C, Bollerslev J, Khan AA, et al. Medical management of primary hyperparathyroidism: proceedings of the fourth International Workshop on the Management of Asymptomatic Primary Hyperparathyroidism. J Clin Endocrinol Metab. 2014; 99(10): 3607–3618.
  6. Marcocci C, Cetani F. Update on the use of cinacalcet in the management of primary hyperparathyroidism. J Endocrinol Invest. 2012; 35(1): 90–95.
  7. Khan AA, Bilezikian JP, Kung AWC, et al. Alendronate in primary hyperparathyroidism: a double-blind, randomized, placebo-controlled trial. J Clin Endocrinol Metab. 2004; 89(7): 3319–3325.
  8. Misiorowski W. [Alendronate increases bone mineral density in patients with symptomatic primary hyperparathyroidism]. Endokrynol Pol. 2005; 56(6): 871–875.
  9. Faggiano A, Di Somma C, Ramundo V, et al. Cinacalcet hydrochloride in combination with alendronate normalizes hypercalcemia and improves bone mineral density in patients with primary hyperparathyroidism. Endocrine. 2011; 39(3): 283–287.
  10. Misiorowski W, Papierska L. Intravenous zoledronic acid effectively decreases serum calcium in primary hyperparathyroidism. Bone. 2006; 38(3): 80–81.
  11. Nemeth EF, Heaton WH, Miller M, et al. Pharmacodynamics of the type II calcimimetic compound cinacalcet HCl. J Pharmacol Exp Ther. 2004; 308(2): 627–635.
  12. Kuczera P, Adamczak M, Więcek A. Safety and efficiency of treatment with cinacalcet of haemodialysed patients with chronic kidney disease and secondary hyperparathyroidism Endokrynol Pol 2013; 64 2: 176–181
  13. Shoback DM, Bilezikian JP, Turner SA, et al. The calcimimetic cinacalcet normalizes serum calcium in subjects with primary hyperparathyroidism. J Clin Endocrinol Metab. 2003; 88(12): 5644–5649.
  14. Peacock M, Bilezikian JP, Klassen PS, et al. Cinacalcet hydrochloride maintains long-term normocalcemia in patients with primary hyperparathyroidism. J Clin Endocrinol Metab. 2005; 90(1): 135–141.
  15. Peacock M, Bolognese MA, Borofsky M, et al. Cinacalcet treatment of primary hyperparathyroidism: biochemical and bone densitometric outcomes in a five-year study. J Clin Endocrinol Metab. 2009; 94(12): 4860–4867.
  16. Schwarz P, Body JJ, Cáp J, et al. The PRIMARA study: a prospective, descriptive, observational study to review cinacalcet use in patients with primary hyperparathyroidism in clinical practice. Eur J Endocrinol. 2014; 171(6): 727–735.
  17. Silverberg SJ, Rubin MR, Faiman C, et al. Cinacalcet hydrochloride reduces the serum calcium concentration in inoperable parathyroid carcinoma. J Clin Endocrinol Metab. 2007; 92(10): 3803–3808.
  18. Marcocci C, Chanson P, Shoback D, et al. Cinacalcet reduces serum calcium concentrations in patients with intractable primary hyperparathyroidism. J Clin Endocrinol Metab. 2009; 94(8): 2766–2772.
  19. Cetani, F., Saponaro, F., Banti, C., Cianferotti, L., Vignali, E., Chiavistelli, S. Cinacalcet efficacy in patients with moderately severe primary hyperparathyroidism according to the European Medicine Agency prescription labeling. J Endocrinol Invest. 2012; 35: 655–660.
  20. Peacock M, Bilezikian JP, Bolognese MA, et al. Cinacalcet HCl reduces hypercalcemia in primary hyperparathyroidism across a wide spectrum of disease severity. J Clin Endocrinol Metab. 2011; 96(1): E9–18.
  21. Khan A, Bilezikian J, Bone H, et al. Cinacalcet normalizes serum calcium in a double-blind randomized, placebo-controlled study in patients with primary hyperparathyroidism with contraindications to surgery. Eur J Endocrinol. 2015; 172(5): 527–535.
  22. Luque-Fernández I, García-Martín A, Luque-Pazos A. Experience with cinacalcet in primary hyperparathyroidism: results after 1 year of treatment. Ther Adv Endocrinol Metab. 2013; 4(3): 77–81.