ECE2014 Poster Presentations Neuroendocrinology (27 abstracts)
Cinacalcet hydrochloride more efficiently controls serum calcium levels in mild-asymptomatic primary hyperparathyroidism without surgery criteria, as compared with surgical cases
Irene Crespo Hernandez 1 , Teresa Ruiz Gracia 1 , Emilia Gomez Hoyos 1, , Ana Ortola Buigues 1 , Martin Cuesta Hernandez 1 , Francisco Fernandez Capel 1 , Paz de Miguel Novoa 1 , Maria Concepción Sanabria Perez 1 , Alfonso Calle Pascual 1 & Isabelle Runkle de la Vega 1
1Hospital Clinico San Carlos, Madrid, Spain, 2Hospital Clinico Valladolid, Valladolid, Spain.
Context: Primary hyperparathyroidism (PHPT) is a common endocrine disease, characterized by the chronic elevation of serum calcium (Ca) levels induced by a long-standing increase of PTH concentrations. PHPT includes mild-asymptomatic and symptomatic forms. Cinacalcet is effective in lowering serum Ca levels in PHPT, but is indicated solely in mild-asymptomatic PHPT meeting surgery criteria. Management of non-surgical mild-asymptomatic PHPT is still a debated issue.
Objective: To compare biochemical efficacy of cinacalcet in controlling Ca levels in mild-asymptomatic PHPT patients fulfilling or not surgery criteria.
Design: This was a retrospective longitudinal cohort study.
Patients: Forty-three sporadic PHPT patients (mean age 62.5±10.6 years) with mild-asymptomatic disease, treated with cinacalcet were included. Two categories were individualized: 23 patients with (category 1) and 20 patients without (category 2) surgery criteria. Median follow-up was 42 months.
Results: At the end of the initiation phase (3-months period with administration of 30 mg qd of cinacalcet), the proportion of patients achieving normocalcemia was significantly greater in the group without indication to surgery (category 2) compared to the group fulfilling criteria for parathyroidectomy (category 1) (90 vs 56.5%; P<0.001). During the length of the study, normalization of serum Ca levels was observed in all enrolled subjects. Median (minimum, maximum) daily dose of cinacalcet effective for obtaining and maintaining normocalcemia was 60 (30, 120) and 30 (30, 45) mg in categories 1 and 2 respectively. Mean time of Ca normalization was significantly lower in category 2 rather than category 1 (3.1 vs 4.2 months; P<0.001). Mean serum Ca levels were significantly lower in patients without surgery indication (category 2) rather than subjects fulfilling surgical criteria (category 1) at 6, 12, and 36 months.
Conclusions: Cinacalcet is more effective in controlling serum calcium levels in non-surgical cases of mild-asymptomatic PHPT. Cinacalcet treatment should be considered in mild-asymptomatic PHPT, independently from the presence of surgery criteria.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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