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NDT Advance Access published online on November 5, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp578
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© The Author 2009. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Restoration of reversed whole PTH/intact PTH ratio and reduction in parathyroid gland vascularity during cinacalcet therapy for severe hyperparathyroidism in a uraemic patient

Hirotaka Komaba1, Jeongsoo Shin2 and Masafumi Fukagawa1,3

1 Division of Nephrology and Kidney Center, Kobe University School of Medicine, Kobe 650-0017, Japan 2 Motomachi HD Clinic, Kobe, 650-0012, Japan 3 Present address: Division of Nephrology and Metabolism, Tokai University School of Medicine, Isehara, 259-1193, Japan

Correspondence and offprint requests to: Masafumi Fukagawa; E-mail: fukagawa{at}tokai-u.jp



  Abstract

Parathyroid hormone (PTH) levels measured with the intact PTH assays are generally higher than those measured with the whole PTH assay; however, rare exceptions to this rule have been reported in patients with severe hyperparathyroidism associated with N-PTH overproduction. We report a haemodialysis patient with severe secondary hyperparathyroidism, in whom abnormally higher whole PTH levels than intact PTH levels were normalized during cinacalcet therapy. Moreover, we observed a marked reduction in parathyroid gland vascularity during this treatment. Our findings suggested that increased sensitivity of the parathyroid calcium sensing receptor by calcimimetics may modulate the secretion or truncation of N-PTH or other PTH molecules that can be detected by the whole PTH assay but not by the intact PTH assays.

Keywords: cinacalcet hydrochloride; intact PTH assay; N-PTH; whole PTH assay

Received for publication: 4. 2.09
Accepted in revised form: 6.10.09


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