Parathyroid Hemorrhage Occurring after Administration of Cinacalcet in a Patient with Secondary Hyperparathyroidism

Abstract

We herein report an unusual case of spontaneous parathyroid gland rupture. A man was admitted with respiratory distress in September 2010. He had been receiving hemodialysis since 1995. He was diagnosed secondary hyperparathyroidism in 2006 and began receiving cinacalcet therapy in 2009. His intact parathyroid hormone (iPTH) level decreased, and massive traumatic bleeding occurred, following which rupture of the parathyroid gland was detected during surgery. The ruptured gland showed nodular hyperplasia. Previous reports have indicated that parathyroid bleeding is associated with glandular hypertrophy. This is the first report of parathyroid apoplexy occurring after suppression of elevated parathyroid function caused by cinacalcet therapy.

Acute airway compromise due to parathyroid tumour apoplexy: an exceptionally rare and potentially life-threatening presentation

“…Haemorrhage extending inferiorly into the mediastinum can manifest as cough, chest pain, dyspnoea, respiratory distress and may mimic aortic dissection. Haemorrhage has also been reported into hyperplastic parathyroid glandular tissue in secondary hyperparathyroidism in patients undergoing haemodialysis [ 3 ] and in one patient after suppression of PTH with cinacalcet [ 4 ]. The parathyroid gland may be functional or non-functional, and the serum calcium can range from high to low depending on the occurrence of gland infarction.…”

Parathyroid Apoplexy Following Cinacalcet Treatment in Primary Hyperparathyroidism

“…A case of parathyroid hemorrhage after administration of cinacalcet in a patient with secondary hyperparathyroidism on hemodialysis requiring emergency surgery has been reported. Authors suggest that parathyroid hemorrhage was the consequence of a glandular degeneration caused by the administration of cinacalcet (22). Our case confirms and expands these findings by showing for the first time its occurrence in a patient with primary hyperparathyroidism.…”