Endocrine Abstracts

An 89 years old caucasian female patient with antecedents of hemithyroidectomy in 2016 due to benign nodular disease, and actually suplemented with 0.1 mg/day of levothyroxine, was referred to the Endocrinology consultation because of a primary hyperparathyroidism diagnosed in the sequence of the study of an episode of nephrolitiasis that happened in 2012 and a diagnosis of osteoporosis that was established in 2017. A 99mTc-Sestamibi revealed an augmented right inferior parathyroid gland. Although the patient had surgical indication for paratiroidectomy (symptomatic hyperparathyroidism), it was decided to treat the patient medically, because of her age and functional dependence, with the agreement of the patient and her family. She was initially treated with alendronic acid 70 mg once week during 5 years, but without significant response in terms of bone mineral density, hypercalcemia and osseous pain. The treatment was then switched to denosumab 60 mg twice year in 2020, and, in 2021, because the hypercalcemia didn’t ameliorate, inspired by the results of the DENOCINA trial, we decided to introduce, in add-on, cinacalcet, initially in the dose of 30 mg/day. The calcium was 11.5 mg/dL and the PTH was 147 pg/mL (with adequate levels of vitamin D) before the initiation of cinalcalcet. Actually, 4 months after the initiation of cinacalcet, with a dose that was titrated to 60 mg/day, the calcium is in the upper limit of the normality (10.5 mg/dL) and the PTH has fallen to 85 pg/ml. But most important, the patient tolerated well both drugs, did experience an improvement in the osseous pain and gained more autonomy in the accomplishment of her daily activities.