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Updated: Jun 1, 2026
03:57
Generation of Hypoparathyroid Rats via Carbon-Nanoparticle-Assisted Parathyroidectomy
Published on: July 14, 2023
Tertiary hyperparathyroidism resistant to cinacalcet treatment
Manabu Okada1, Yoshihiro Tominaga, Kumiko Izumi
1Department of Transplantation and Endocrine Surgery, Nagoya Second Red Cross Hospital, Showa-ku, Nagoya, Japan.
Summary
Cinacalcet resistance in tertiary hyperparathyroidism may be linked to enlarged parathyroid glands. Severely enlarged nodular glands appear to be a key factor in treatment non-response.
Area of Science:
- Nephrology
- Endocrinology
- Surgical Pathology
Background:
- Tertiary hyperparathyroidism (THPT) is a common complication in patients with chronic kidney disease.
- Cinacalcet hydrochloride (cinacalcet) is a calcimimetic agent used to manage THPT.
- Treatment resistance to cinacalcet necessitates alternative therapeutic strategies, such as parathyroidectomy (PTx).
Purpose of the Study:
- To investigate the clinical characteristics and course of patients with THPT resistant to cinacalcet treatment.
- To identify potential factors contributing to cinacalcet resistance in THPT patients.
Main Methods:
- Retrospective analysis of five THPT patients who underwent PTx due to cinacalcet resistance.
- Evaluation of parathyroid gland size via ultrasonography prior to renal transplantation.
- Monitoring of serum calcium, phosphorus, intact parathyroid hormone (iPTH), alkaline phosphatase (ALP), and creatinine (Cr) levels before and after cinacalcet administration and PTx.
Main Results:
- All five patients exhibited at least one parathyroid gland with a maximum diameter exceeding 1 cm (mean diameter: 18.7 mm).
- Serum iPTH and ALP levels showed a gradual increase following cinacalcet initiation.
- Post-PTx, transient increases in Cr levels were observed.
Conclusions:
- Severely enlarged nodular hyperplastic parathyroid glands appear to be a significant factor contributing to cinacalcet resistance in THPT.
- Parathyroid gland size may predict treatment response to cinacalcet in THPT patients.
- Further research is warranted to explore the relationship between gland morphology and calcimimetic efficacy.
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