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).
Similar content being viewed by others
References
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.
Eknoyan G, Levin A, Levin NW. Bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003;42:1–201.
Investigators TET. Effect of cinacalcet on cardiovascular disease in patients undergoing dialysis. N Engl J Med. 2012;367:2482–94.
Lazar ES, Stankus N. Dialysis rounds: cinacalcet-induced hungry bone syndrome. Seminars in dialysis. Hoboken: Wiley; 2007. pp. 83–5.
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.
Cruz DN, Perazella MA. Biochemical aberrations in a dialysis patient following parathyroidectomy. Am J Kidney Dis. 1997;29:759–68.
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.
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.
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.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
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.
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13730-017-0284-z