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The effect of cinacalcet on intraoperative findings in tertiary hyperparathyroidism patients undergoing parathyroidectomy.

AbstractINTRODUCTION:
Tertiary hyperparathyroidism (3HPTH) patients who undergo parathyroidectomy (PTX) are often managed with calcium lowering medications such as cinacalcet (Sensipar) before surgery. Here, we assess how cinacalcet treatment influences intraoperative parathyroid hormone (IOPTH) kinetics and surgical findings in 3HPTH patients undergoing PTX.
METHODS:
We reviewed retrospectively 113 patients 3HPTH who underwent PTX, 14 of whom were taking cinacalcet and 112 who were not taking the drug. IOPTH levels fitted to linear curves versus time were used to evaluate the role of cinacalcet.
RESULTS:
Cinacalcet did not correlate with rates of cure (P = .41) or recurrence (P = .54). Patients taking cinacalcet experienced a steeper decrease in IOPTH compared with those not taking the medication (P = .005). Cinacalcet treatment was associated with an increase in rate of hungry bones (P = .04). Weights of the heaviest glands resected (P = .02) and preoperative PTH levels (P = .0004) were greater among patients taking cinacalcet.
CONCLUSION:
Perioperative cinacalcet treatment in patients with 3HPTH alters IOPTH kinetics by causing a steeper decrease in IOPTH, but does not require modification of the standard IOPTH protocol. Although cinacalcet use does not adversely affect cure rates, it is associated with greater preoperative PTH and an increased incidence of hungry bones, hence serving as an indicator of more severe disease. Cinacalcet does not need to be held before operation.
AuthorsYash R Somnay, Eric Weinlander, David F Schneider, Rebecca S Sippel, Herbert Chen
JournalSurgery (Surgery) Vol. 156 Issue 6 Pg. 1308-13; discussion 1313-4 (Dec 2014) ISSN: 1532-7361 [Electronic] United States
PMID25456900 (Publication Type: Comparative Study, Journal Article)
CopyrightCopyright © 2014 Elsevier Inc. All rights reserved.
Chemical References
  • Naphthalenes
  • Parathyroid Hormone
  • Cinacalcet
Topics
  • Adult
  • Cinacalcet
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Hyperparathyroidism, Secondary (diagnosis, drug therapy, surgery)
  • Male
  • Middle Aged
  • Monitoring, Intraoperative (methods)
  • Naphthalenes (therapeutic use)
  • Parathyroid Hormone (analysis)
  • Parathyroidectomy (methods)
  • Preoperative Care (methods)
  • Reference Values
  • Retrospective Studies
  • Severity of Illness Index
  • Treatment Outcome

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