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

Area of Science:

• Nephrology
• Endocrinology
• Pharmacology

Background:

• Secondary hyperparathyroidism is common in end-stage renal disease (ESRD).
• Cinacalcet is a calcimimetic agent used to treat secondary hyperparathyroidism in ESRD patients.
• Hypocalcemia is a known, usually reversible, side effect of cinacalcet therapy.

Purpose of the Study:

• To report a rare case of severe, symptomatic, and prolonged hypocalcemia due to cinacalcet in an ESRD patient.
• To highlight the potential for cinacalcet to induce a state of pharmacological parathyroidectomy and hungry bone syndrome.

Main Methods:

• Case report of a 55-year-old male ESRD patient.
• Detailed clinical observation and laboratory monitoring of serum calcium levels.
• Treatment with high-dose elemental calcium and vitamin D receptor activation therapy (VDRA).

Main Results:

• The patient developed severe, symptomatic hypocalcemia two weeks after initiating cinacalcet.
• The condition mimicked pharmacological parathyroidectomy and led to hungry bone syndrome.
• Serum calcium normalized after four weeks of discontinuing cinacalcet and intensive treatment.

Conclusions:

• Cinacalcet can precipitate severe hypocalcemia, necessitating vigilant monitoring in ESRD patients.
• Aggressive management with calcium and VDRA is effective in resolving cinacalcet-induced hypocalcemia and hungry bone syndrome.
• This case underscores the importance of recognizing and managing this rare but serious complication.