Parathyroid Carcinoma Medication

Updated: Aug 29, 2018
  • Author: Lawrence Kim, MD, FACS, FACE; Chief Editor: Neetu Radhakrishnan, MD  more...
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Medication

Medication Summary

No medical treatment is available for parathyroid carcinoma except to reduce hypercalcemia. Medications used for that purpose are the calcimimetic agent cinacalcet, bisphosphonates, and calcitonin. However, hypercalcemia due to parathyroid cancer is often resistant to long-term medical management.

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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.

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.

Pamidronate (Aredia)

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

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.

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.

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.

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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