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Nikolaos Asonitis, Eva Kassi, Michalis Kokkinos, Ilias Giovanopoulos, Foteini Petychaki and Helen Gogas

cases of persistent HHM, the administration of calcimimetic cinacalcet could be an additional effective therapeutic option, although the exact mechanism of this action remains to be elucidated. Case presentation A 69-year-old female was admitted

Open access

Kirun Gunganah, Ashley Grossman and Maralyn Druce

. Genetic testing confirmed the diagnosis and showed a G to A (c.1703G>A) nucleotide substitution in exon 6 of calcium-sensing receptor ( CASR ). Treatment She was initially started on 30 mg of cinacalcet daily. Although her calcium levels improved

Open access

Marisa M Fisher, Susanne M Cabrera and Erik A Imel

, namely cinacalcet (9) . Three previous case studies have shown the successful use of cinacalcet, in NSHPT (8) (10) (11) . Here we report the cases of two unrelated patients with de novo R185Q heterozygous inactivating CASR mutations and

Open access

K Nadarasa, M Bailey, H Chahal, O Raja, R Bhat, C Gayle, A B Grossman and M R Druce

patients often develop resistance over time. Calcimimetics, such as cinacalcet, have been used to lower serum calcium levels, but there is currently no evidence that they alter the natural course of the disease (1) . The available literature on the

Open access

E Mogas, A Campos-Martorell, M Clemente, L Castaño, A Moreno-Galdó, D Yeste and A Carrascosa

the CASR gene and most patients are asymptomatic. Cinacalcet has been successfully used in adults with PHPT. In pediatric patients, it is a drug generally used for treatment of secondary hyperparathyroidism. However, its use in PHPT is exceptional

Open access

Reiner Jumpertz von Schwartzenberg, Ulf Elbelt, Manfred Ventz, Knut Mai, Tina Kienitz, Lukas Maurer, Thomas Rose, Jens C Rückert, Christian J Strasburger and Joachim Spranger

calcimimetics are more effective in lowering calcium levels and bear less side effects. Palliative medical therapy in parathyroid cancer patients today is mainly based on the use of intravenous bisphosphonates and calcimimetics such as cinacalcet hydrochloride

Open access

Maria P Yavropoulou, Nikolina Gerothanasi, Athanasios Frydas, Evangelia Triantafyllou, Chris Poulios, Prodromos Hytiroglou, Panagiotis Apostolou, Ioannis Papasotiriou, Symeon Tournis, Isaak Kesisoglou and John G Yovos

demonstrated diffuse hyperplasia of the resected parathyroid gland with no signs of malignancy. PTH and serum calcium levels were decreased after parathyroidectomy, but they did not normalize and thus the patient was started on cinacalcet together with oral

Open access

Marina Tsoli, Anna Angelousi, Dimitra Rontogianni, Constantine Stratakis and Gregory Kaltsas

treated with intravenous fluids, furosemide, zoledronic acid and cinacalcet, but the patient died twelve years after initial diagnosis. Discussion Parathyroid carcinoma is an extremely rare, slowly evolving malignancy that accounts for less of 1

Open access

Ravikumar Ravindran, Justyna Witczak, Suhani Bahl, Lakdasa D K E Premawardhana and Mohamed Adlan

cinacalcet was tried as it was felt that primary hyperparathyroidism could be contributing to his hypercalcaemia – his PTH was not completely supressed despite markedly raised calcium levels, that is, 2 mmol/L (1.6–7.2). The cinacalcet helped lower his

Open access

Maryam Heidarpour, Mehdi Karami, Pegah Hedayat and Ashraf Aminorroaya


Primary hyperparathyroidism revealed by thoracic spine brown tumor and peptic ulcer bleeding is rare. We presented a case of 33-year-old male patient who was admitted with paraplegia. Thoracic spine magnetic resonance imaging (MRI) showed extradural lesion at T4 level. He underwent surgical decompression in T4. According to histopathologic finding and elevated serum parathormone (PTH) and hypercalcemia (total serum calcium 12.1 mg/dL), the diagnosis of brown tumor was down. Ultrasonography of his neck showed a well-defined lesion of 26 × 14 × 6 mm. The day after surgery, he experienced 2 episodes of melena. Bedside upper gastrointestinal endoscopy showed gastric peptic ulcer with visible vessel. Treatment with intragastric local instillation of epinephrine and argon plasma coagulation was done to stop bleeding. After stabilization of the patient, parathyroidectomy was performed. Histologic study showed the parathyroid adenoma without any manifestation of malignancy. At discharge, serum calcium was normal (8.6 mg/dL). On 40th day of discharge, standing and walking status was normal.

Learning points:

  • Thoracic spine involvement is a very rare presentation of primary hyperparathyroidism.
  • The issue of whether primary hyperparathyroidism increases the risk of peptic ulcer disease remains controversial. However, gastrointestinal involvement has been reported in association with classic severe primary hyperparathyroidism.
  • The treatment of brown tumor varies from case to case.