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Simona Zerbi, Pio Ruggiero, Luciano A. Pedrini, Massive Soft Tissue Calcifications and Cinacalcet, The Journal of Clinical Endocrinology & Metabolism, Volume 93, Issue 4, 1 April 2008, Pages 1121–1122, https://doi.org/10.1210/jc.2007-2211
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Extract
A 37-yr-old man on long-term hemodialysis developed a relapse of secondary hyperparathyroidism after subtotal parathyroidectomy. Dialysis treatment adjustment and conventional medical therapies, involving noncalcium phosphate binders and active vitamin D sterols, proved ineffective. Painful and rapidly increasing tumor-like masses appeared over the second finger and the back of his right hand. Laboratory studies showed persistent serum levels of intact PTH of more than 1500 pg/ml and calcium-phosphate product of more than 100 mg2/dl2 [recommended levels in dialysis patients, 150–300 pg/ml (16.5–33 pmol/liter) and <55 mg2/dl2, respectively] (1). A radiograph of the right hand revealed massive soft tissue swelling and calcifications (Fig. 1).
Due to the patient’s disinclination for further surgical treatment, we decided to administer cinacalcet (2, 3), a calcimimetic agent, at doses of 30–60 mg/d, achieving a significant suppression of intact PTH (350 pg/ml) and calcium-phosphate product (60 mg2/dl2). After correction of the calcium-phosphate product, oral calcitriol and calcium acetate were administered. Six months later, a radiographic control showed the disappearance of the calcifications (Fig. 2).
