Endocrine Abstracts

Primary hyperparathyroidism (PHPT) is a common condition. The prevalence since the introduction of multichannel analysers is approximately 1:1000, with the older female being the typical patient. PHPT is predominantly a sporadic disorder. Surgery remains the only curative approach to most primary hyperparathyroidism (PHPT), medical treatment with cinacalcet has been proven to be an alternative for patients with hyperparathyroidism.

Objective: Analyze treatment with cinacalcet, in older patient with primary hyperparathyroidism not tributary of surgery.

Material and patients: Between 2011 and 2015, 13 patients with PHPT who were not suitable for surgery were identified. Data collected: age, gender, comorbidities, levels of calcium and PTH and follow-up.

Results: We present 13 patients 8 women and 5 man with a mean of age 80.5±6.59 year-old (range 71–92). Comorbidities, diabetes mellitus 50%, frailty 58%, heart disease 40%, depression 33%, cognitive impairment 17%. Calcium levels previous treatment was 11.85±0.28 mgr/dl and PTH 123±34 pg/ml. T cinacalcet 30 mg. daily was initiated, in 12 patients and 60 mgr. in one. Patients were followed for 1–4 years (2.75±1.21) calcium were adequately controlled (9.98±0.78 mgr/dl), but PTH 112.4±42 pg/ml remains high, renal function was uncharged in all patients. Two patients died during the follow-up, not related with hyperparathyroidism. Adverse events were observed in 1 patient (vomiting) that disappeared to diminishing doses.

Discussion: Geriatricians will readily recognize the clinical conundrum of an incidental finding of PHPT in the older that was unexpected. Retrospective questioning may identify some pertinent symptoms, but none strong enough on their own to have made the diagnosis obvious prior to testing serum calcium. This group of patients is hard to define and hence there is little published guidance on how to manage the increasingly common clinical scenario of the frail, relatively asymptomatic, older patient with PHPT.

Conclusions: Cinacalcet, the first available calcimimetic, increases the sensitivity of the calcium-sensing receptor (CaR) to circulating serum calcium, thereby safely reducing serum calcium and PTH concentrations in patients with mild-to-moderate PHPT, intractable disease, and also parathyroid carcinoma. Cinacalcet in a reasonable and safe alternative to treatment of PHPT not tributary of surgery.