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A patient with MEN1-associated hyperparathyroidism, responsive to cinacalcet
Alberto Falchetti1, Antonio Cilotti, Luca Vaggelli
1University Hospital of Careggi, Florence, Italy.
Nature Clinical Practice. Endocrinology & Metabolism
|April 17, 2008
Summary
A patient with Multiple Endocrine Neoplasia type 1 (MEN1) experienced recurrent hyperparathyroidism. Pharmacological treatment with cinacalcet effectively normalized calcium and parathyroid hormone levels, offering a viable alternative to surgery.
Area of Science:
- Endocrinology
- Genetics
- Oncology
Background:
- A 30-year-old woman diagnosed with Multiple Endocrine Neoplasia type 1 (MEN1) presented with primary hyperparathyroidism and an anterior pituitary macroadenoma.
- Genetic analysis confirmed MEN1 with a 1555insG frameshift mutation.
- Initial parathyroidectomy with forearm autotransplantation resolved hyperparathyroidism, but recurrence was noted in 2006.
Observation:
- Elevated serum calcium and parathyroid hormone (PTH) levels were detected in 2006.
- Imaging revealed a metabolically active parathyroid nodule in the neck.
- The patient opted for pharmacological management over repeat surgery.
Findings:
- Cinacalcet treatment normalized serum calcium and PTH levels within one month.
- The parathyroid nodule remained morphologically unchanged during one year of follow-up.
- Cinacalcet was well-tolerated with no adverse events reported.
Implications:
- Cinacalcet presents a significant pharmacological option for managing primary hyperparathyroidism in MEN1 patients.
- This treatment can be considered both before surgery and for managing postsurgical recurrences.
- Pharmacological intervention with cinacalcet offers a less invasive approach for MEN1-associated hyperparathyroidism.
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