Search

A 6-month observational study was conducted in 61 patients (33 men and 28 women, mean age 54.8 +/- 12.4 years) treated with cinacalcet in whom parathyroid intervention was indicated. Thirty-seven patients had baseline intact parathyroid hormone (iPTH) levels of >500 pg/mL, but only five still had levels this high after 6-month cinacalcet therapy. No patients had phosphorus (P), calcium (Ca), or iPTH levels within the target range at baseline, but six patients (9.8%) reached all three target ranges after treatment. The stratum with many patients who had 2-4 enlarged parathyroid glands shifted toward the low PTH groups (iPTH < 300 pg/mL) with treatment. There was less of a tendency for patients with more enlarged glands, that is, 10 mm or larger at baseline, to have a higher PTH level after cinacalcet treatment. There was no significant difference in the total volume of parathyroid glands after treatment, since some glands enlarged while others shrank. These findings indicate cinacalcet to be a potentially useful treatment. Our results suggest that 80% of cases indicated for parathyroid intervention could avoid such interventional therapies with cinacalcet administration. However, the variability in the gland-shrinking effect of cinacalcet on parathyroid glands merits further study.

Secondary hyperparathyroidism is one of the common and important abnormalities of mineral metabolism in hemodialysis patients. In this study we investigated the relationship between the weight of individual parathyroid glands (PTG) and their secretion of parathyroid hormone (PTH). Sixty-four PTGs in 16 patients undergoing parathyroidectomy (PTx) at our hospital were included in this study. Patients' ages ranged from 34 to 68 years (60.3 +/- 6.6 years). They were undergoing maintenance dialysis therapy for 81-256 months (175.3 +/- 56.0 months). The cause of end-stage renal failure was chronic glomerulonephritis in all patients. We measured whole PTH (wPTH) levels before PTx and 15 min after the resection of each individual gland (Delta whole PTH). A positive correlation was found between the weight of individual gland and ultrasonography (US) size of individual PTG (r = 0.91, P < 0.001, N = 53). A positive correlation was found between the total mass of the gland and the total volume of PTG on US (r = 0.896, P < 0.001, N = 16). A positive correlation was found between the mass of each individual gland and Delta whole PTH (r = 0.625, P < 0.001, N = 64); however, massive PTGs did not secrete more whole PTH per unit mass (0.01 g). Determination of the volume of PTGs by US is a good indicator of their weight. Larger PTGs secrete more whole PTH per gland, whereas these PTGs did not have the ability to secrete more PTH per unit volume.