Parathyroid Carcinoma Medication

  • Author: Lawrence Kim, MD; Chief Editor: Jules E Harris, MD   more...
 
Updated: Dec 7, 2011
 

Medication Summary

No medical treatment is available for parathyroid carcinoma except to reduce hypercalcemia. However, hypercalcemia associated with parathyroid carcinoma is often severe and refractory to medical treatment.

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Calcimimetic Agent

Class Summary

These agents bind to and modulate the parathyroid calcium-sensing receptor, increase sensitivity to extracellular calcium, and reduce parathyroid hormone secretion.

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Cinacalcet (Sensipar)

 

Directly lowers parathyroid hormone (PTH) levels by increasing sensitivity of calcium-sensing receptor on chief cell of parathyroid gland to extracellular calcium. Also results in concomitant serum calcium decrease.

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Bisphosphonate

Class Summary

Bisphosphonates are analogs of pyrophosphate and act by binding to hydroxyapatite in bone-matrix, thereby inhibiting the dissolution of crystals. They prevent osteoclast attachment to the bone matrix and osteoclast recruitment and viability.

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Pamidronate (Aredia)

 

Inhibits normal and abnormal bone resorption. Appears to inhibit bone resorption without inhibiting bone formation and mineralization.

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Alendronate (Fosamax)

 

Available in the United States, but not yet indicated for treatment of hypercalcemia; alendronate probably is useful for long-term prevention of recurrence of hypercalcemia following use of more conventional therapy (ie, hydration and pamidronate). Useful in preventing and treating osteoporosis, which is a complication of prolonged mild hypercalcemia.

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Etidronate disodium (Didronel)

 

First-generation bisphosphonate that has been shown to increase bone density at spine and femoral neck, though studies have failed to demonstrate a decrease in fractures. Acts principally by inhibiting bone resorption and does not alter renal tubular reabsorption of calcium. The effects of etidronate increase as the dose increases.

Does not affect hypercalcemia in patients with hyperparathyroidism.

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Zoledronic acid (Zometa)

 

Inhibits bone resorption possibly by acting on osteoclasts or osteoclast precursors. Median duration of complete response (maintaining normalized calcium levels) and time to relapse reported as 32 and 30 d, respectively.

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Human calcitonin analogs

Class Summary

These agents promote the renal excretion of calcium, making them suitable for the treatment of hypercalcemia.

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Calcitonin (Miacalcin, Osteocalcin)

 

Lowers elevated serum calcium in patients with multiple myeloma, carcinoma, or primary hyperparathyroidism. Can expect a higher response when serum calcium levels are high.

Onset of action is approximately 2 h following injection and activity lasts for 6-8 h. May lower calcium levels for 5-8 d by about 9% if given q12h. IM route is preferred at multiple injection sites with dose >2 mL.

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Contributor Information and Disclosures
Author

Lawrence Kim, MD  Professor, Departments of Surgery and Medicine, Director of Surgical Endocrinology, University of Arkansas for Medical Sciences; Staff Surgeon, Central Arkansas Veterans Affairs Healthcare System

Lawrence Kim, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American Association of Endocrine Surgeons, American College of Surgeons, Association for Academic Surgery, Association of VA Surgeons, International Association of Endocrine Surgeons, Society of Surgical Oncology, Society of University Surgeons, and Southwestern Surgical Congress

Disclosure: Nothing to disclose.

Specialty Editor Board

Sanjiv S Agarwala, MD  Chief of Oncology and Hematology, St Luke's Cancer Center, St Luke's Hospital and Health Network; Professor, Temple University Shool of Medicine

Sanjiv S Agarwala, MD is a member of the following medical societies: American Association for Cancer Research, American Society for Head and Neck Surgery, American Society of Clinical Oncology, Eastern Cooperative Oncology Group, and European Society for Medical Oncology

Disclosure: BMS Honoraria Speaking and teaching; Novartis Consulting fee Consulting; Merck Consulting fee Consulting

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Wendy Hu, MD  Consulting Staff, Department of Hematology/Oncology and Bone Marrow Transplantation, Huntington Memorial Medical Center

Wendy Hu, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Blood and Marrow Transplantation, American Society of Hematology, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Rajalaxmi McKenna, MD, FACP  Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems

Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis

Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD  Clinical Professor of Medicine, Division of Hematology/Medical Oncology, Department of Internal Medicine, University of Arizona College of Medicine; Consulting Staff, Arizona Cancer Center

Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research

Disclosure: GlobeImmune Salary Consulting

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Photomicrograph of parathyroid carcinoma showing typical fibrotic septae. Histologic diagnosis can be difficult.
 
 
 
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