Endocrine Abstracts

Introduction: We report a case of malignant hypercalcemia complicated by acute pancreatitis, in a patient whose cardiac insufficiency obliged us to use an unconventional therapeutic means: calcimimetics

Case Report: Mrs. Halima, 74 years old, had a history of arterial hypertension complicated by ischemic heart disease at the stage of heart failure. She consulted the emergency room for typical pancreatic pain, the biological workup found a lipasemia at 30 times normal and acute renal failure, the abdominal CT scan was in favor of an acute pancreatitis stage E of Balthazaar.The etiological investigation found malignant hypercalcemia (140 mg/l) secondary to primary hyperparathyroidism (PTH: 679 pg/ml).the patient was put on fasting, with analgesic treatmentFor hypercalcemia, hyperhydration was not possible in the presence of decompensated cardiac insufficiency, and biphosphonates were contraindicated in the presence of kidney failureFaced with the reduced therapeutic choices, our attitude was to prescribe cinacalcet at a progressive dose: 30 mg per day then 60 mg per day, the calcemia went in two days from 140 mg/l to 120 mg/l then to 100 mg/l, as regards the adverse effects; our patient presented only one episode of vomiting the first day.After stabilization, she benefited from a localization check-up which revealed a parathyroid nodule, and the evolution was favorable after surgical removal.

Discussion: Cinacalcet is an oral calcimimetic that mimic the effects of calcium on the calcium receptors of the parathyroid cell. It lowers blood calcium and reduces PTH concentration.[1] Initially used in hyper parathyroid hypercalcemia associated with end-stage renal disease is actually FDA approved to treat secondary HPT in patients with parathyroid carcinoma (2011) [2], and hypercalcemia in patients with primary HPT who are unable to undergo Para thyroidectomy.but its use in malignant hypercalcemia in emergency situations has not been recommended, in some cases, and when the classical treatment of hypercalcemia is not possible, as in our patient’s case, calcimimetics, and in particular cinacalcet, can be the most effective therapeutic option to save the patient

Conclusion: we suggest that the use of this therapeutic class may be useful in urgent situations in patients with cardiac or kidney failure when hyper hydration is not possible[1] Wada M., and Nagano N.: Control of parathyroid cell growth by calcimimetics. Nephrol Dial Transplant 2003; 18: pp. iii13-iii17[2] Silverberg S.J. et al: Cinacalcet hydrochloride reduces the serum calcium concentration in inoperable parathyroid carcinoma. J Clin Endocrinol Metab 2007; 92: pp. 3803-3808