Question

Are there medications to treat primary hyperparathyroidism?


Answer
Deva Boone
Answer authored by Deva Boone
Deva Boone, MD is the founder of the Southwest Parathyroid Center. As one of the most experienced parathyroid surgeons in the U.S., she has treated thousands of patients with parathyroid conditions.

There are no medications that cure primary hyperparathyroidism. The only cure is with an operation to remove the diseased parathyroid glands. There are medications that can decrease calcium and PTH levels, but they are not treating the underlying problem. They can make your levels look better on paper, but not necessarily make you any healthier.

Cinacalcet (Sensipar) is a medication that is occasionally prescribed for primary hyperparathyroidism to control the calcium level. Cinacalcet is more appropriately used in secondary hyperparathyroidism due to chronic kidney failure. It really isn’t a great medication for primary hyperparathyroidism, but some patients take it. For most patients, it is not indicated. The indicated treatment for primary hyperparathyroidism is an operation, not a medication. Sensipar has side effects that make it intolerable for many people, and it does not seem to prevent bone loss from parathyroid disease. It can make some symptoms better, but the preferred treatment is still parathyroidectomy, which cures the condition. 

There are just a few scenarios in which Sensipar would be indicated:

  1. For someone who has very very high calcium levels (usually calcium over 14 mg/dl) that are causing acute confusion and hospitalization, who cannot get surgery right away. Sensipar can be a bridge to more definitive surgical cure.

  2. For someone with severe symptoms who has already had a failed parathyroid operation (or multiple operations) and who has no surgical options. This would be true if someone had already had a four-gland parathyroid exploration and a diseased parathyroid was not found. For most patients who are uncured after surgery, I do not recommend Sensipar. But if the symptoms are severe or the calcium is very high and cannot be controlled, Sensipar is an option. 

If someone can have an, that is the first-line treatment for primary hyperparathyroidism. Medications to control the PTH or calcium levels are only for patients who cannot get an operation, or who need to control very high calcium levels before getting an operation. 

Cinacalcet (Sensipar) Treatment