Hospital Virgen de la Salud, Avda. Barber n 30, Toledo, Spain.
Ther Adv Endocrinol Metab. 2013 Jun;4(3):77-81. doi: 10.1177/2042018813482344.
To assess the characteristics of patients with primary hyperparathyroidism (PHPT) treated with cinacalcet and to evaluate its efficacy in reducing serum calcium and parathyroid hormone (PTH) concentrations after 1 year of treatment.
The study included 20 patients with PHPT who had completed at least 12 months of treatment with cinacalcet (eight patients for refusal of parathyroidectomy, three for surgery not possible due to comorbidities and nine for progressive hypercalcemia prior to surgery). We recorded clinical and biochemical data at baseline, and after 3, 6 and 12 months of treatment. We also monitored adverse events. Cinacalcet was administered in increasing doses until normal serum calcium was reached or side effects preventing a further increase occurred.
After 3 months of treatment, serum calcium significantly decreased (11.73 ± 0.85 versus 10.71 ± 1.63 mg/dl, p < 0.001) and serum phosphorus significantly increased (2.41 ± 0.48 versus 2.63 ± 0.70 mg/dl, p = 0.004) while no significant change occurred in PTH (181.91 ± 102.37 versus 195.47 ± 111.71 pg/ml, p = 0.695). No further variation was observed after 6 months compared with 3 months of follow up. However, after 12 months of treatment, there was a significant decrease in PTH concentrations compared with baseline (181.91 ± 102.37 versus 152.47± 70.16 pg/ml, p = 0.028) as well as serum calcium (11.73 ± 0.85 versus 10.20± 0.95 mg/dl, p < 0.001); serum phosphorus significantly increased (2.41 ± 0.48 versus 2.71 ± 0.43 mg/dl, p = 0.01). Normocalcemia (S-Ca < 10.2 mg/dl) was achieved in 55% of patients. The medication was usually well tolerated (83.4%). Most common adverse events were nausea and vomiting, especially at the beginning of therapy.
Cinacalcet rapidly reduced serum calcium in patients with PHPT and this reduction remained stable after 1 year of treatment. We also observed a decrease in PTH. Cinacalcet is an effective alternative in nonsurgical treatment of PHPT and may be useful in the preoperative hypercalcemia management.
评估使用西那卡塞治疗甲状旁腺功能亢进症（PHPT）患者的特征，并评估其在治疗 1 年后降低血清钙和甲状旁腺激素（PTH）浓度的疗效。
该研究纳入了 20 例完成至少 12 个月西那卡塞治疗的 PHPT 患者（8 例因拒绝甲状旁腺切除术，3 例因合并症无法手术，9 例术前进行性高钙血症）。我们在基线时以及治疗后 3、6 和 12 个月记录临床和生化数据。我们还监测了不良事件。西那卡塞逐渐增加剂量，直到达到正常血清钙水平或出现阻止进一步增加的副作用。
治疗 3 个月后，血清钙显著下降（11.73±0.85 与 10.71±1.63mg/dl，p＜0.001），血清磷显著升高（2.41±0.48 与 2.63±0.70mg/dl，p=0.004），而 PTH 无明显变化（181.91±102.37 与 195.47±111.71pg/ml，p=0.695）。与 3 个月随访相比，6 个月时无进一步变化。然而，治疗 12 个月后，与基线相比，PTH 浓度显著下降（181.91±102.37 与 152.47±70.16pg/ml，p=0.028），血清钙也显著下降（11.73±0.85 与 10.20±0.95mg/dl，p＜0.001）；血清磷显著升高（2.41±0.48 与 2.71±0.43mg/dl，p=0.01）。55%的患者达到正常血钙（S-Ca＜10.2mg/dl）。药物通常耐受性良好（83.4%）。最常见的不良事件是恶心和呕吐，尤其是在治疗开始时。
西那卡塞可迅速降低 PHPT 患者的血清钙，治疗 1 年后这种降低仍保持稳定。我们还观察到 PTH 下降。西那卡塞是 PHPT 非手术治疗的有效替代药物，在术前高钙血症的管理中可能有用。
