Extract

Sir,

Calcimimetic compounds, such as cinacalcet, reduce parathyroid hormone (PTH) secretion in patients with secondary hyperparathyroidism, as Fukagawa et al . demonstrated in the recent NDT article [ 1 ]. However, whether calcimimetic compound can reduce the size of an already-swollen parathyroid gland (PTG) is unclear. Here we report our observations of changes in the PTG size in a single case of secondary hyperparathyroidism treated with cinacalcet.

The patient was a 59-year-old woman who had been receiving haemodialyis since December 2003 for nondiabetic end-stage renal failure. In December 2006, elevated levels of serum intact PTH and alkaline phosphatase (ALP) were found (Table 1 ). Ultrasound examination revealed swelling of the right upper, right lower and left upper lobes of the PTG. Intravenous administration of the vitamin D analogue maxacalcitol (Oxarol®, Chugai Pharmaceutical Co., Ltd, Tokyo, Japan) reduced the levels of both intact PTH and ALP; however, the PTG (especially the left upper lobe) gradually enlarged, and the product of the serum levels of calcium and inorganic phosphorus (Ca × Pi) reached 100 mg 2 /dL 2 .

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