Successful treatment of inoperable recurrent secondary hyperparathyroidism with cinacalcet HCl

Secondary hyperparathyroidism is a common complication for patients with end-stage renal disease (ESRD). When it progresses, it is associated with morbidity and mortality [1]. Phosphate binders and vitamin D can be used to prevent the progression of secondary hyperparathyroidism. However, these conservative treatments often fail to control severe hyperparathyroidism. In such cases, parathyroidectomy is required. Despite medical management after parathyroidectomy, persistent or recurrent hyperparathyroidism can occur. One of the causes of recurrent hyperparathyroidism is parathyromatosis, which has been described as multiple nodules or rests of hyperfunctioning parathyroid tissue that become evident following parathyroidectomy. We describe a female haemodialysis patient diagnosed with secondary hyperparathyroidism, which was probably caused by parathyromatosis. Treatment with cinacalcet, a calcimimetic agent, in combination with vitamin D was extremely effective.