Top

Published in:

Open Access 01-12-2018 | Case report

A case of hyperparathyroidism-associated parkinsonism successfully treated with cinacalcet hydrochloride, a calcimimetic

Authors: Yuichiro Ohya, Masato Osaki, Shota Sakai, Shunsuke Kimura, Chiharu Yasuda, Tetsuro Ago, Takanari Kitazono, Shuji Arakawa

Published in: BMC Neurology | Issue 1/2018

Abstract

Background

Some metabolic disorders, including abnormal calcium metabolism, can develop and worsen parkinsonism. However, whether hyperparathyroidism can cause parkinsonism remains controversial.

Case presentation

An 83-year-old woman with a history of right thalamic hemorrhage and drug-induced parkinsonism, was admitted due to worsening of parkinsonian symptoms including mask-like face, bradykinesia, freezing of gait, and rigidity. She had been diagnosed with autoimmune hepatitis and was being treated with prednisolone. Examinations revealed hypercalcemia (14.3 mg/dL) with an increased level of intact parathyroid hormone (iPTH) (361 pg/mL). Her symptoms were resistant to some additional anti-parkinsonian drugs; however, cinacalcet hydrochloride, a calcimimetic for the treatment of secondary hyperparathyroidism, normalized levels of serum calcium and iPTH, and remarkably improved her symptoms.

Conclusions

In the present case, we speculate that hypercalcemia probably due to secondary hyperparathyroidism that had developed during steroid therapy deteriorated the parkinsonism.

De Rosa A, Rinaldi C, Tucci T, Pappatà S, Rossi F, Morra VB, Faggiano A, Colao A, De Michele G. Co-existence of primary hyperparathyroidism and Parkinson's disease in three patients: an incidental finding? Parkinsonism Relat Disord. 2011;17(10):771–3.CrossRefPubMed

Vaamonde J, Legarda I, Jimenez-Jimenez J, Zubieta JL, Obeso JA. Levodopa-responsive parkinsonism associated with basal ganglia calcification and primary hypoparathyroidism. Mov Disord. 1993;8(3):398–400.CrossRefPubMed

Margolin D, Hammerstad J, Orwoll E, McClung M, Calhoun D. Intracranial calcification in hyperparathyroidism associated with gait apraxia and parkinsonism. Neurology. 1980;30(9):1005–7.CrossRefPubMed

Müller R, Benker G, Windeck R, Reinwein D, Jörg J. Hemiparkinson syndrome in hyperparathyroidism. Dtsch Med Wochenschr. 1985;110(31–32):1231–2.PubMed

Hirooka Y, Yuasa K, Hibi K, Ishikawa A, Sobue G, Naruse T, Mitsuma T. Hyperparathyroidism associated with parkinsonism. Intern Med. 1992;31(7):904–7.CrossRefPubMed

Kovacs CS, Howse DC, Yendt ER. Reversible parkinsonism induced by hypercalcemia and primary hyperparathyroidism. Arch Intern Med. 1993;153(9):1134–6. 10CrossRefPubMed

Sumida K, Nakamura M, Ubara Y, Marui Y, Tanaka K, Takaichi K, Tomikawa S, Inoshita N, Ohashi K. Histopathological alterations of the parathyroid glands in haemodialysis patients with secondary hyperparathyroidism refractory to cinacalcet hydrochloride. J Clin Pathol. 2011;64:756–60.CrossRefPubMed

Sumida K, Nakamura M, Ubara Y, Marui Y, Tanaka K, Takaichi K, Tomikawa S, Inoshita N, Ohashi K. Cinacalcet up-regulates calcium-sensing receptors of parathyroid glands in hemodialysis patients. Am J Nephrol. 2013;37:405–12.CrossRefPubMed

Tatsumi R, Komaba H, Kanai G, Miyakogawa T, Sawada K, Kakuta T, Fukagawa M. Cinacalcet induces apoptosis in parathyroid cells in patients with secondary hyperparathyroidism: histological and cytological analyses. Nephron Clin Pract. 2013;124:224–31.CrossRefPubMed

10.

Rocchitta G, Migheli R, Mura MP, Grella G, Esposito G, Marchetti B, Miele E, Desole MS, Miele M, Serra PA. Signaling pathways in the nitric oxide and iron-induced dopamine release in the striatum of freely moving rats: role of extracellular Ca2+ and L-type Ca2+ channels. Brain Res. 2005;1047(1):18–29.CrossRefPubMed

11.

Bartlett SE, Enquist J, Hopf FW, Lee JH, Gladher F, Kharazia V, Waldhoer M, Mailliard WS, Armstrong R, Bonci A, Whistler JL. Dopamine responsiveness is regulated by targeted sorting of D2 receptors. Proc Natl Acad Sci U S A. 2005;102(32):11521–6.CrossRefPubMedPubMedCentral

12.

An HX, Jin ZF, Ge XF, Wu J, Chen C, Zhang FM, Qu W, Liu XG, Liu SY. Parathyroid hormone (1-34)-induced apoptosis in neuronal rat PC12 cells: implications for neurotoxicity. Pathol Res Pract. 2010;206(12):821–7.CrossRefPubMed

Title: A case of hyperparathyroidism-associated parkinsonism successfully treated with cinacalcet hydrochloride, a calcimimetic
Authors: Yuichiro Ohya
Masato Osaki
Shota Sakai
Shunsuke Kimura
Chiharu Yasuda
Tetsuro Ago
Takanari Kitazono
Shuji Arakawa
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Neurology / Issue 1/2018
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/s12883-018-1067-7

At a glance: The STEP trials

Springer Medicine

A case of hyperparathyroidism-associated parkinsonism successfully treated with cinacalcet hydrochloride, a calcimimetic

Abstract

Background

Case presentation

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Case presentation

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

Batten disease: biochemical and molecular characterization revealing novel PPT1 and TPP1 gene mutations in Indian patients

Association between socioeconomic status and post-stroke functional outcome in deprived rural southern China: a population-based study

Daily repetitive sensory stimulation of the paretic hand for the treatment of sensorimotor deficits in patients with subacute stroke: RESET, a randomized, sham-controlled trial

Predictors of post-stroke fever and infections: a systematic review and meta-analysis

Revealing Alzheimer’s disease genes spectrum in the whole-genome by machine learning

Peripheral neuropathy in a case with CADASIL: a case report