A Neurocognitive Improvement with Cinacalcet, what is the Relationship?

Background: Primary hyperparathyroidism (pHPT) is a common endocrine disorder. In elderly patients with multiple co-morbidities, the decision to “watch and wait” is often most clinically appropriate as operative intervention is associated with high peri-operative risk1. We present an elderly patient with severe hypercalcemia secondary to pHPT. Case History: A 82-year-old female with a history of diabetes mellitus, hypertension and progressive cognitive and motor impairment classified as atypical parkinsonism came to ED due to a drowsy state. The laboratory investigations showed a severe hypercalcemia associated to increase of PTH. CT and scintigraphic exams highlighted a left parathyroid adenoma with a diagnosis of pHTP. In the meantime she was treated with forced hydration and diuretics and subsequently cinacalcet, given the comorbidity and the bedridden situation. We obtained a normalization and stability of the calcemia values and a clear improvement in vigilance and cognitive picture. Discussion: Significant functional and cognitive impairment can occur with elevated serum calcium levels in pHTP2. The calcimimetic Cinacalcet almost always controls hypercalcemia and hypophosphatemia sufficiently. Given the high tolerability, affordability, and ongoing beneficial effects on serum calcium, cinacalcet should be considered in people presenting with cognitive impairment and elevated serum calcium who are unfit for definitive surgical management.