Cinacalcet versus parathyroidectomy for primary hyperparathyroidism: a single centre experienc

Abstract

Background and Aim. Parathyroidectomy is the standard treatment for primary hyperparathyroidism (PHPT). Cinacalcet, an allosteric modulator of the calcium sensing receptor, has been shown to be effective in reducing serum calcium levels and it has gained prominence as a non-invasive treatment in PHTH. Aim of the study was to compare the efficacy and tolerability of medical therapy vs surgery in a cohort of PHPT patients. Patients and Methods. The study included 63 consecutive subjects (14 men and 49 women, median age 62.4 ± 12 yr) with PHPT: 50 subjects (40 F and 10 M, ratio F/M 4:1; median age 59.6 ± 16.6 years, range 37-82) underwent parathyroidectomy, while 13 (9 F and 4 M, ratio F/M 2.5:1, median age 76.5 ± 6.2 years, range 64-83), who were ineligible for surgery, were treated with cinacalcet. Cinacalcet was administered at increasing dosages until normal serum calcium was reached or side effects occurred. Serum calcium and PTH was measured and adverse events were monitored during a 12 month-duration follow-up. Results. All patients who had undergone parathyroidectomy normalized both serum calcium and PTH levels after surgery (P=0.001 vs baseline) and none of them experienced persistent and/or recurrent PHPT during follow-up. In the group under cinacalcet therapy, serum calcium significantly decreased in all patients within 4 weeks (P = 0.01 vs baseline) and normalized in all patients at prolonged follow-up (P=0.001 vs baseline), while PTH slightly decreased during follow-up (P=0.878 vs baseline) and never reached a normal value. Conclusion. Surgical treatment is curative and safe in most cases of PHPT. Cinacalcet represents an effective therapeutic option, from the perspective of hypercalcemia improvement, in PHPT patients who have contraindications to surgery or persistent PHPT after surgery.