Cinacalcet increases renal calcium excretion in PTHrP-mediated hypercalcemia: a case report

BMC Endocrine Disorders

Case Report

Gregory Ku¹  Kristen Lavelle¹  Tina Hu¹  Dolores Shoback²  Samya Faiq³ 

[1]Department of Medicine, Division of Endocrinology and Metabolism, University of California, San Francisco, 513 Parnassus Ave, HSW 1027, 94143, San Francisco, CA, USA

[2]Department of Medicine, Division of Endocrinology and Metabolism, University of California, San Francisco, 513 Parnassus Ave, HSW 1027, 94143, San Francisco, CA, USA

[3]Department of Veterans Affairs, Endocrine Research Unit, San Francisco, CA, USA

[4]School of Medicine, University of California Davis, Davis, USA

关键词: Osteonecrosis;    Bisphosphonate;    Hypercalcemia;    PTHrP;    Cinacalcet;    Case report;   

DOI  :  10.1186/s12902-023-01386-3

 received in 2022-10-13, accepted in 2023-06-08,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundIn the acute setting, PTH-independent hypercalcemia is typically treated with anti-resorptive agents such as zoledronic acid or denosumab. When these agents are no longer able to control hypercalcemia, several case reports have shown the utility of cinacalcet. However, it is not known if cinacalcet can be effective in patients naïve to anti-resorptive therapy or how cinacalcet ameliorates the hypercalcemia.Case presentationA 47-year-old male with a history of alcohol-induced cirrhosis was admitted for left cheek bleeding and swelling from an infiltrative squamous cell carcinoma of the oral cavity. On admission, he was found to have an elevated albumin-corrected serum calcium of 13.6 mg/dL, a serum phosphorus of 2.2 mg/dL and an intact PTH of 6 pg/mL (normal 18–90) with a PTHrP of 8.1 pmol/L (normal < 4.3), consistent with PTHrP-dependent hypercalcemia. Aggressive intravenous saline hydration and subcutaneous salmon calcitonin were initiated, but his serum calcium remained elevated. Given tooth extractions scheduled for the next day and possible irradiation to the jaw in the near future, alternatives to antiresorptive therapy were sought. Cinacalcet was initiated at 30 mg twice daily then increased to 60 mg twice daily the following day. The albumin-corrected serum calcium level decreased from 13.2 to 10.9 mg/dL within 48 h. The fractional excretion of calcium increased from 3.7 to 7.0%.ConclusionsThis case demonstrates the utility of cinacalcet for the treatment of PTHrP-mediated hypercalcemia without prior anti-resorptive therapy via increased renal clearance of calcium.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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Fig. 1