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Hungry bone syndrome two weeks after starting cinacalcet: a call for caution

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Abstract

Cinacalcet is an effective and safe alternative to parathyroidectomy in end stage renal disease (ESRD) patients with secondary hyperparathyroidism. Hypocalcemia is a known complication of treatment that is usually readily reversible upon discontinuation of the drug. It rarely manifests severely and symptomatically requiring hospital admission. We present the case of a 55 year old man with severe, symptomatic and prolonged hypocalcemia that occurred 2 weeks after starting cinacalcet. Cinacalcet induced a state of pharmacological parathyroidectomy with subsequent hungry bone syndrome. Serum calcium returned to normal range after 4 weeks of stopping the drug while receiving high doses of elemental calcium and vitamin D receptor activation therapy (VDRA).

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References

  1. Goodman WG, Hladik GA, Turner SA, et al. The calcimimetic agent AMG 073 lowers plasma parathyroid hormone levels in hemodialysis patients with secondary hyperparathyroidism. J Am Soc Nephrol. 2002;13:1017–24.

    CAS  PubMed  Google Scholar 

  2. Eknoyan G, Levin A, Levin NW. Bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003;42:1–201.

    Article  Google Scholar 

  3. Investigators TET. Effect of cinacalcet on cardiovascular disease in patients undergoing dialysis. N Engl J Med. 2012;367:2482–94.

    Article  Google Scholar 

  4. Lazar ES, Stankus N. Dialysis rounds: cinacalcet-induced hungry bone syndrome. Seminars in dialysis. Hoboken: Wiley; 2007. pp. 83–5.

    Google Scholar 

  5. Novick T, McMahon BA, Berliner A, Jaar BG. Cinacalcet-associated severe hypocalcemia resulting in torsades de pointes and cardiac arrest: a case for caution. Eur J Clin Pharmacol. 2016;72:373–5.

    Article  PubMed  Google Scholar 

  6. Cruz DN, Perazella MA. Biochemical aberrations in a dialysis patient following parathyroidectomy. Am J Kidney Dis. 1997;29:759–68.

    Article  CAS  PubMed  Google Scholar 

  7. Sumida K, Nakamura M, Ubara Y, et al. Cinacalcet upregulates calcium-sensing receptors of parathyroid glands in hemodialysis patients. Am J Nephrol 2013;37:405–12.

    Article  Google Scholar 

  8. Goto S, Fujii H, Matsui Y, Fukagawa M. Marked increase in bone formation markers after cinacalcet treatment by mechanisms distinct from hungry bone syndrome in a haemodialysis patient. NDT Plus. 2010;3:71–3.

    PubMed  Google Scholar 

  9. Stewart ZA, Blackford A, Somervell H, et al. 25-hydroxyvitamin D deficiency is a risk factor for symptoms of postoperative hypocalcemia and secondary hyperparathyroidism after minimally invasive parathyroidectomy. Surgery. 2005;138:1018–26.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Nephrology, Department of Internal Medicine, American University of Beirut, Riad El Solh, P.O. Box 11-0236, Beirut, 1107 2020, Lebanon

    Sahar H. Koubar, Walid Medawar & Ali K. Abu-Alfa

  2. Division of Nephrology, Department of Internal Medicine, Maine Medical Center, Maine, USA

    Abd Assalam Qannus

Authors
  1. Sahar H. Koubar
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  2. Abd Assalam Qannus
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  3. Walid Medawar
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  4. Ali K. Abu-Alfa
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Corresponding author

Correspondence to Sahar H. Koubar.

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Conflict of interest

Dr. Ali Abu-Alfa has consulted for Amgen in the past 12 months. The rest of the authors report no conflict of interest.

Research involving human participants/animals

This article does not contain any studies with human participants or animals performed by any of the authors.

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An informed consent was obtained from the patient reported.

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Koubar, S.H., Qannus, A.A., Medawar, W. et al. Hungry bone syndrome two weeks after starting cinacalcet: a call for caution. CEN Case Rep 7, 21–23 (2018). https://doi.org/10.1007/s13730-017-0284-z

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  • DOI: https://doi.org/10.1007/s13730-017-0284-z

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