Endocrine Abstracts

Background: The treatment of choice for symptomatic primary hyperparathyroidism (PHPT) is surgery, however in many cases patient choice or medical comorbidities preclude this treatment modality.

Aim: This audit examines the use of cinacalcet in management of primary hyperparathyroidism in a district general hospital to determine if it is in accordance with the National institute for health and care excellence (NICE) guidance (May 2019).

Method: We retrospectively analysed the data for all patients diagnosed with PHPT and treated with Cinacalcet in a district general hospital over a 12 month period.

Results: 16 patients (10 female) were prescribed cinacalcet with an average age of 76. 100% of patients had calcium levels above 2.85 with symptoms or end organ damage, replete vitamin D levels and parathyroid hormone levels in keeping with PHPT. Urinary calcium:creatinine excretion ratio was appropriately screened to exclude familial hypocalciuric hypercalcaemia (FHH) in 14{87.5%} patients. 1{6.25%} patient was receiving cinacalcet for symptomatic FHH. 8{50%} patients were deemed unfit for surgery whilst 3{18.75%} are awaiting surgery. 2{12.5%} patients underwent unsuccessful surgery. 3/16{18.75%} patients refused Surgery. 10{62.5%} patients achieved a normalisation in calcium post cinacalcet treatment. 14{87.5%} patients had renal imaging with a total of 2{12.5%} having renal Calculi identified. In total 87.5% of cinacalcet prescriptions were compliant with NICE guidance. 16{100%} patients received a DEXA scan within 6 months of first clinic review

Conclusions: The study finds the majority of patients were able to achieve a normalisation in calcium following cinacalcet treatment. Predominantly cinacalcet was appropriately administered in accordance with NICE guidance. The results showed that cinacalcet had also been used as a bridging agent prior to definitive surgical intervention. This shows not all Cinacalcet prescriptions were compliant with NICE guidance but were deemed clinically necessary to prevent worsening hypercalcaemia.