Calcium-carbonate/cinacalcet/lanthanum-carbonate

Abstract

Treatment refractory: case report A 32-year-old man’s tumoral calcinosis was refractory to lanthanum carbonate, calcium carbonate and cinacalcet therapy. The man, who had a history of renal failure was undergoing chronic hemodialysis for 4 years. He presented with progressive swelling and pain in the right clavicle, right hip and left shoulder which started 6 months earlier. Radiographs and CT showed giant calcified masses near the right clavicle, right hip and left shoulder. A neck ultrasound scan revealed normal thyroid gland and three enlarged parathyroid glands. Parathyroid scintigraphy revealed a hyper-functional parathyroid gland. Later, he was diagnosed with tumoral calcinosis due to severe hyperphosphatemia and secondary hyperparathyroidism. He received lanthanum carbonate 1,500 mg/day, calcium carbonate 3,000 mg/day and cinacalcet 75 mg/day [routes not stated]. However, the tumoral calcinosis was refractory to lanthanum carbonate, calcium carbonate and cinacalcet therapy. Therefore, the man was admitted and underwent total parathyroidectomy and auto-transplantation in the right arm. Pathological examination revealed that all four parathyroid glands had a histological nodular hyperplasia pattern. Postoperatively, he developed apparent hungry bone syndrome and his intact parathyroid hormone levels decreased. He was discharged. Within 3 months following the surgery, the multiple tumoral calcinosis lesions and his symptoms resolved.