Department of Endocrinology and Diabetes Mellitus, Fukuoka University Chikushi Hospital, Chikushino, Japan.
Department of Endocrinology and Diabetes Mellitus, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jyonan-ku, Fukuoka City, Fukuoka, 814-0180, Japan.
J Bone Miner Metab. 2021 Jul;39(4):583-588. doi: 10.1007/s00774-020-01190-2. Epub 2021 Jan 6.
Cinacalcet is a calcimimetic that modulates the functions of calcium-sensing receptor and is currently used to treat patients with primary hyperparathyroidism (PHPT). Although it was reported that cinacalcet treatment reduced the size of hyperplastic parathyroid glands in patients with secondary hyperparathyroidism, whether or not cinacalcet treatment can reduce the size of parathyroid adenomas in patients with PHPT has been unknown.
We recruited nine (male: one, female: eight) patients with PHPT due to parathyroid adenomas who did not undergo parathyroidectomy. Cinacalcet was administered at a dose of 50 mg/day, and we evaluated the size of parathyroid adenomas (width × thickness) (mm) using ultrasonography before and after 6 months of cinacalcet treatment.
The mean age of the subjects was 58.1 ± 7.2 years old, and the mean serum intact parathyroid hormone (PTH) concentration was 134.8 ± 8.7 pg/ml. All participants showed hypercalcemia and osteopenia. After 6 months, the mean size of parathyroid adenomas was significantly decreased (baseline: 73.8 ± 33.4 mm vs. after 6 months: 52.5 ± 25.0 mm, p = 0.045). Thus, 6-month cinacalcet treatment induced a 29% size reduction in parathyroid adenomas. Furthermore, the serum intact PTH concentration before cinacalcet treatment was positively correlated with the reduction in the size of parathyroid adenomas.
The present study revealed that cinacalcet treatment reduces the size of parathyroid adenomas in patients with PHPT. The accumulation of more PHPT cases with cinacalcet therapy is required to confirm this finding.
西那卡塞是一种钙敏感受体调节剂，目前用于治疗原发性甲状旁腺功能亢进症（PHPT）。尽管有报道称西那卡塞治疗可使继发性甲状旁腺功能亢进症患者的增生甲状旁腺缩小，但西那卡塞治疗是否可使 PHPT 患者的甲状旁腺瘤缩小尚不清楚。
我们招募了 9 名（男 1 例，女 8 例）因甲状旁腺瘤而未接受甲状旁腺切除术的 PHPT 患者。西那卡塞的剂量为 50mg/天，我们在开始治疗前和治疗 6 个月后使用超声评估甲状旁腺瘤的大小（宽度×厚度）（mm）。
受试者的平均年龄为 58.1±7.2 岁，平均血清全段甲状旁腺激素（PTH）浓度为 134.8±8.7pg/ml。所有参与者均表现为高钙血症和骨质疏松症。治疗 6 个月后，甲状旁腺瘤的平均大小显著减小（基线：73.8±33.4mm 比治疗 6 个月后：52.5±25.0mm，p=0.045）。因此，6 个月的西那卡塞治疗使甲状旁腺瘤缩小了 29%。此外，治疗前的血清全段 PTH 浓度与甲状旁腺瘤大小的缩小呈正相关。
本研究表明，西那卡塞治疗可使 PHPT 患者的甲状旁腺瘤缩小。需要积累更多接受西那卡塞治疗的 PHPT 病例来证实这一发现。
