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European Surgery
Published in: European Surgery 4/2017

01-08-2017 | case report

Hypercalcemia resistant to cinacalcet caused by a mediastinal hyperplastic parathyroid gland in a renal transplant patient

Authors: Manabu Okada, MD, Kenta Futamura, MD, Takahisa Hiramitsu, MD, PhD, Makoto Tsujita, MD, Norihiko Goto, MD, PhD, Shunji Narumi, MD, PhD, Yoshihiko Watarai, MD, PhD, Toshihiro Ichimori, MD, Yoshihiro Tominaga, MD, PhD

Published in: European Surgery | Issue 4/2017

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Summary

Background

Renal hyperparathyroidism is a common complication in patients with chronic kidney disease. Cinacalcet, a kind of calcimimetic, has been reported to be an effective and safe treatment option in renal transplant patients with hyperparathyroidism. However, some patients require parathyroidectomy due to resistance to cinacalcet treatment. It is uncertain when we should give up treatment with cinacalcet and perform parathyroidectomy for persistent hyperparathyroidism.

Case report

We experience the first documented case in which cinacalcet-resistant hypercalcemia was caused by a mediastinal hyperplastic parathyroid gland after renal transplantation. The patient received total parathyroidectomy with autograft 4 years before renal transplantation. The levels of serum calcium and parathyroid hormone were controlled well with 25 mg daily of cinacalcet. Despite continuous treatment with cinacalcet, the patient developed hypercalcemia, hypercalciuria and nephrocarcinosis after renal transplantation. A mediastinal parathyroid lesion was revealed by imaging. Eventually, parathyroidectomy was performed for the mediastinal gland for the purpose of preventing new stone formation in the renal graft.

Conclusion

It was suggested that prompt parathyroidectomy is preferable rather than prolonged medical treatment for hypercalcemia resistant to cinacalcet caused by persistent hyperparathyroidism after renal transplantation. Furthermore, we should be extremely careful about hypercalcinuria and nephrocalcinosis when we prescribe cinacalcet for patients under hypercalcemia.
Literature
1.
Dey V, Farrah TE, Traynor JP, Spalding EM, Robertson SE, Geddes CC. Symptomatic fracture risk in the renal replacement therapy population. Nephorol Dial Transplant. 2016. doi:10.​1093/​ndt/​gfw222. Epub ahead of print.
2.
Tentori F, Wang M, Bieber BA, Karaboyas A, Li Y, Jacobson SH, et al. Recent changes in therapeutic approaches and association with outcomes among patients with secondary hyperparathyroidism on chronic hemodialysis: the DOPPS study. Clin J Am Soc Nephrol. 2015;10(1):98–109.CrossRefPubMed
3.
Tassone F, Guarnieri A, Castellano E, Baffoni C, Attanasio R, Borretta G. Parathyroidectomy halts the deterioration of renal function in primary hyperparathyroidism. J Clin Endocrinol Metab. 2015;100(8):3069–73.CrossRefPubMed
4.
Evenepoel P, Claes K, Kuypers D, Maes B, Bammens B, Vanrenterghem Y. Natural history of parathyroid function and calcium metabolism after kidney transplantation: a single-centre study. Nephrol Dial Transplant. 2004;19(5):1281–7.CrossRefPubMed
5.
Copley JB, Wüthrich RP. Therapeutic management of post-kidney transplant hyperparathyroidism. Clin Transplant. 2011;25(1):24–39.CrossRefPubMed
6.
Pérez-Ricart A, Galicia-Basart M, Alcalde-Rodrigo M, Segarra-Medrano A, Suñé-Negre JM, Montoro-Ronsano JB. Effectiveness of cinacalcet in patients with chronic kidney disease and secondary hyperparathyroidism not receiving dialysis. PLOS ONE. 2016; doi:10.​1371/​journal.​pone.​0161527.PubMedPubMedCentral
7.
8.
Toro Prieto FJ, Bernal Blanco G, Navarro García M, Cabello Chaves V, Garcíajiménez R, Pereira Palomo P, et al. Calcimimetics and bone mineral density in renal transplant patients with persistent secondary hyperparathyroidism. Transplant Proc. 2009;41(6):2144–7.CrossRefPubMed
9.
Copley JB, Germain M, Stern L, Pankewycz O, Katznelson S, Shah T, et al. Evaluation of cinacalcet HCl treatment after kidney transplantation. Transplant Proc. 2010;42(7):2503–8.CrossRefPubMed
10.
Paschoalin RP, Torregrosa JV, Barros X, Durán CE, Campistol JM. Cinacalcet de novo in persistent hypercalcemia after kidney transplantation secondary to hyperparathyroidism: long-term follow-up and effect of withdrawal. Transplant Proc. 2012;44(8):2376–8.CrossRefPubMed
11.
Borchhardt KA, Heinzl H, Mayerwöger E, Hörl WH, Haas M, Sunder-Plassmann G. Cinacalcet increases calcium excretion in hypercalcemic hyperparathyroidism after kidney transplantation. Transplantation. 2008;86(7):919–24.CrossRefPubMed
12.
Serra AL, Schwarz AA, Wick FH, Marti HP, Wüthrich RP. Successful treatment of hypercalcemia with cinacalcet in renal transplant recipients with persistent hyperparathyroidism. Nephrol Dial Transplant. 2005;20(7):1315–9.CrossRefPubMed
13.
Okada M, Tominaga Y, Izumi K, Nobata H, Yamamoto T, Hiramitsu T, et al. Tertiary hyperparathyroidism resistant to cinacalcet treatment. Ther Apher Dial. 2011;15:33–7.CrossRefPubMed
14.
Messa P, Regalia A, Alfieri CM, Cresseri D, Forzenigo L, Gandolfo MT, et al. Current indications to parathyroidectomy in CKD patients before and after renal transplantation. J Nephrol. 2013;26(6):1025–32.CrossRefPubMed
15.
Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG, Chertow GM. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol. 2004;15(8):2208–18.CrossRefPubMed
16.
Stevens LA, Djurdjev O, Cardew S, Cameron EC, Levin A. Calcium, phosphate, and parathyroid hormone levels in combination and as a function of dialysis duration predict mortality: evidence for the complexity of the association between mineral metabolism and outcomes. J Am Soc Nephrol. 2004;15(3):770–9.CrossRefPubMed
17.
Block GA, Hulbert-Shearon TE, Levin NW, Port FK. Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis. 1998;31(4):607–17.CrossRefPubMed
18.
Block GA, Port FK. Re-evaluation of risks associated with hyperphosphatemia and hyperparathyroidism in dialysis patients: recommendations for a change in management. Am J Kidney Dis. 2000;35(6):1226–37.CrossRefPubMed
19.
Yamamoto T, Tominaga Y, Okada M, Hiramitsu T, Tsujita M, Narumi S, et al. Characteristics of persistent hyperparathyroidism after renal transplantation. World J Surg. 2016;40(3):600–6.CrossRefPubMed
20.
Bleskestad IH, Bergrem H, Leivestad T, Hartmann A, Gøransson LG. Parathyroid hormone and clinical outcome in kidney transplant patients with optimal transplant function. Clin Transplant. 2014;28(4):479–86.CrossRefPubMed
21.
Srinivas TR, Schold JD, Womer KL, Kaplan B, Howard RJ, Bucci CM, et al. Improvement in hypercalcemia with cinacalcet after kidney transplantation. Clin J Am Soc Nephrol. 2006;1(2):323–6.CrossRefPubMed
22.
Nagano N. Pharmacological and clinical properties of calcimimetics: calcium receptor activators that afford an innovative approach to controlling hyperparathyroidism. Pharmacol Ther. 2006;109(3):339–65.CrossRefPubMed
23.
Block GA, Martin KJ, de Francisco AL, Turner SA, Avram MM, Suranyi MG, et al. Cinacalcet for secondary hyperparathyroidism in patients receiving hemodialysis. N Engl J Med. 2004;350(15):1516–25.CrossRefPubMed
24.
Lindberg JS, Culleton B, Wong G, Borah MF, Clark RV, Shapiro WB, et al. Cinacalcet HCl, an oral calcimimetic agent for the treatment of secondary hyperparathyroidism in hemodialysis and peritoneal dialysis: a randomized, double-blind, multicenter study. J Am Soc Nephrol. 2005;16(3):800–7.CrossRefPubMed
25.
Messa P, Macário F, Yaqoob M, Bouman K, Braun J, von Albertini B, et al. The OPTIMA study: assessing a new cinacalcet (Sensipar/Mimpara) treatment algorithm for secondary hyperparathyroidism. Clin J Am Soc Nephrol. 2008;3(1):36–45.CrossRefPubMedPubMedCentral
26.
Lee HH, Kim AJ, Ro H, Jung JY, Chang JH, Chung W, et al. Sequential changes of vitamin D level and parathyroid hormone after kidney transplantation. Transplant Proc. 2016;48(3):897–9.CrossRefPubMed
27.
Rodriguez M, Felsenfeld AJ, Llach F. Calcemic response to parathyroid hormone in renal failure: role of calcitriol and the effect of parathyroidectomy. Kidney Int. 1991;40(6):1063–8.CrossRefPubMed
28.
Slatopolsky E, Finch J, Clay P, Martin D, Sicard G, Singer G, et al. A novel mechanism for skeletal resistance in uremia. Kidney Int. 2000;58(2):753–61.CrossRefPubMed
29.
Torres A, Lorenzo V, Salido E. Calcium metabolism and skeletal problems after transplantation. J Am Soc Nephrol. 2002;13(2):551–8.PubMed
30.
Serra AL, Braun SC, Starke A, Savoca R, Hersberger M, Russmann S, et al. Pharmacokinetics and pharmacodynamics of cinacalcet in patients with hyperparathyroidism after renal transplantation. Am J Transplant. 2008;8(4):803–10.CrossRefPubMed
31.
Seager CM, Srinivas TR, Flechner SM. Development of nephrolithiasis in a renal transplant patient during treatment with Cinacalcet. Ann Transplant. 2013;18:31–5.CrossRefPubMed
32.
Boulanger H, Haymann JP, Fouqueray B, Mansouri R, Metivier F, Sarfati E, et al. Therapeutic failure of cinacalcet in a renal transplant patient presenting hyperparathyroidism with severe hypercalcaemia. Nephrol Dial Transplant. 2005;20(12):2865.CrossRefPubMed
33.
Schlosser K, Endres N, Celik I, Fendrich V, Rothmund M, Fernández ED. Surgical treatment of tertiary hyperparathyroidism: the choice of procedure matters! World J Surg. 2007;31(10):1947–53.CrossRefPubMed
34.
Hsieh TM, Sun CK, Chen YT, Chou FF. Total parathyroidectomy versus subtotal parathyroidectomy in the treatment of tertiary hyperparathyroidism. Am Surg. 2012;78(5):600–6.PubMed
35.
Park JH, Kang SW, Jeong JJ, Nam KH, Chang HS, Chung WY, et al. Surgical treatment of tertiary hyperparathyroidism after renal transplantation: a 31-year experience in a single institution. Endocr J. 2011;58(10):827–33.CrossRefPubMed
36.
Tominaga Y, Matsuoka S, Uno N, Tsuzuki T, Hiramitsu T, Goto N, et al. Removal of autografted parathyroid tissue for recurrent renal hyperparathyroidism in hemodialysis patients. World J Surg. 2010;34(6):1312–7.CrossRefPubMed
Metadata
Title
Hypercalcemia resistant to cinacalcet caused by a mediastinal hyperplastic parathyroid gland in a renal transplant patient
Authors
Manabu Okada, MD
Kenta Futamura, MD
Takahisa Hiramitsu, MD, PhD
Makoto Tsujita, MD
Norihiko Goto, MD, PhD
Shunji Narumi, MD, PhD
Yoshihiko Watarai, MD, PhD
Toshihiro Ichimori, MD
Yoshihiro Tominaga, MD, PhD
Publication date
01-08-2017
Publisher
Springer Vienna
Published in
European Surgery / Issue 4/2017
Print ISSN: 1682-8631
Electronic ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-017-0484-y

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