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Case Reports
. 2023 Jun 16;23(1):133.
doi: 10.1186/s12902-023-01386-3.

Cinacalcet increases renal calcium excretion in PTHrP-mediated hypercalcemia: a case report

Samya Faiq  1 , Kristen Lavelle  2 , Tina Hu  2 , Dolores Shoback  2   3 , Gregory Ku  4
Affiliations
Case Reports

Cinacalcet increases renal calcium excretion in PTHrP-mediated hypercalcemia: a case report

Samya Faiq et al. BMC Endocr Disord. .

Abstract

Background: In the acute setting, PTH-independent hypercalcemia is typically treated with anti-resorptive agents such as zoledronic acid or denosumab. When these agents are no longer able to control hypercalcemia, several case reports have shown the utility of cinacalcet. However, it is not known if cinacalcet can be effective in patients naïve to anti-resorptive therapy or how cinacalcet ameliorates the hypercalcemia.

Case presentation: A 47-year-old male with a history of alcohol-induced cirrhosis was admitted for left cheek bleeding and swelling from an infiltrative squamous cell carcinoma of the oral cavity. On admission, he was found to have an elevated albumin-corrected serum calcium of 13.6 mg/dL, a serum phosphorus of 2.2 mg/dL and an intact PTH of 6 pg/mL (normal 18-90) with a PTHrP of 8.1 pmol/L (normal < 4.3), consistent with PTHrP-dependent hypercalcemia. Aggressive intravenous saline hydration and subcutaneous salmon calcitonin were initiated, but his serum calcium remained elevated. Given tooth extractions scheduled for the next day and possible irradiation to the jaw in the near future, alternatives to antiresorptive therapy were sought. Cinacalcet was initiated at 30 mg twice daily then increased to 60 mg twice daily the following day. The albumin-corrected serum calcium level decreased from 13.2 to 10.9 mg/dL within 48 h. The fractional excretion of calcium increased from 3.7 to 7.0%.

Conclusions: This case demonstrates the utility of cinacalcet for the treatment of PTHrP-mediated hypercalcemia without prior anti-resorptive therapy via increased renal clearance of calcium.

Keywords: Bisphosphonate; Case report; Cinacalcet; Hypercalcemia; Osteonecrosis; PTHrP.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Imaging of a large squamous cell carcinoma of the oral cavity. A Cross sectional CT image demonstrating a 6.8 × 8.0 × 7.5 cm vascular soft tissue mass originating in the alveolar ridge of the left mandibular ramus with significant bony destruction. B X-ray prior to full mouth dental extraction showing 3 remaining teeth with gross caries and bony destruction of the left mandible
Fig. 2
Fig. 2
Serum calcium and PTHrP with major interventions. Left axis shows albumin-corrected serum calcium. Right axis shows PTHrP
See this image and copyright information in PMC

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