Advertisement

CEN Case Reports

, Volume 7, Issue 1, pp 21–23 | Cite as

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

  • Sahar H. Koubar
  • Abd Assalam Qannus
  • Walid Medawar
  • Ali K. Abu-Alfa
Case Report

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).

Keywords

Hypocalcemia Secondary hyperparathyroidism Cinacalcet Hungry bone syndrome 

Notes

Compliance with ethical standards

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.

Informed consent

An informed consent was obtained from the patient reported.

References

  1. 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.PubMedGoogle Scholar
  2. 2.
    Eknoyan G, Levin A, Levin NW. Bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003;42:1–201.CrossRefGoogle Scholar
  3. 3.
    Investigators TET. Effect of cinacalcet on cardiovascular disease in patients undergoing dialysis. N Engl J Med. 2012;367:2482–94.CrossRefGoogle Scholar
  4. 4.
    Lazar ES, Stankus N. Dialysis rounds: cinacalcet-induced hungry bone syndrome. Seminars in dialysis. Hoboken: Wiley; 2007. pp. 83–5.Google Scholar
  5. 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.CrossRefPubMedGoogle Scholar
  6. 6.
    Cruz DN, Perazella MA. Biochemical aberrations in a dialysis patient following parathyroidectomy. Am J Kidney Dis. 1997;29:759–68.CrossRefPubMedGoogle Scholar
  7. 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.CrossRefGoogle Scholar
  8. 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.PubMedGoogle Scholar
  9. 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.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Nephrology 2017

Authors and Affiliations

  • Sahar H. Koubar
    • 1
  • Abd Assalam Qannus
    • 2
  • Walid Medawar
    • 1
  • Ali K. Abu-Alfa
    • 1
  1. 1.Division of Nephrology, Department of Internal MedicineAmerican University of BeirutBeirutLebanon
  2. 2.Division of Nephrology, Department of Internal MedicineMaine Medical CenterMaineUSA

Personalised recommendations