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Histopathological alterations of the parathyroid glands in haemodialysis patients with secondary hyperparathyroidism refractory to cinacalcet hydrochloride
  1. Keiichi Sumida1,
  2. Michio Nakamura1,
  3. Yoshifumi Ubara1,
  4. Yuji Marui1,
  5. Kiho Tanaka1,
  6. Kenmei Takaichi1,
  7. Shinji Tomikawa1,
  8. Naoko Inoshita2,
  9. Kenichi Ohashi2
  1. 1Nephrology Center, Toranomon Hospital, Tokyo, Japan
  2. 2Department of Pathology, Toranomon Hospital, Tokyo, Japan
  1. Correspondence to Dr Michio Nakamura, Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, Japan; mnakamura{at}


Background Cinacalcet treatment for secondary hyperparathyroidism (SHPT) has demonstrated parathyroid size regression and morphological changes, such as cystic degeneration and hypovascularisation, on ultrasonography.; However, there have been very few reports regarding the histopathological alterations of hyperplastic parathyroid glands in patients with SHPT after administration of cinacalcet. The aim of this study was to elucidate the effects of cinacalcet for histopathological alterations on the parathyroid glands.

Methods A total of 92 hyperplastic parathyroid glands were obtained from 24 dialysis patients with severe SHPT who underwent total parathyroidectomy and were enrolled in this study. Patients were divided into those treated with and without cinacalcet (cinacalcet group and conventional group, respectively; both n=12). The areas of oxyphil cells, cystic degeneration, haemorrhagic changes and haemosiderin deposition were assessed semiquantitatively.

Results Total maximal parathyroid gland weight and maximal-to-minimal parathyroid gland weight ratio were significantly higher in the cinacalcet group compared with the conventional group (1798.7±1658.3 mg vs 764.2±471.1 mg, p=0.018, 15.8±13.9 vs p=0.047, 6.6±4.2, respectively). Significant increases were observed in oxyphil cell area (61.7%±17.1% vs 36.7%±15.6%, p=0.001) and haemosiderosis score (1.50±1.24 vs 0.42±0.51, p=0.029) in the former rather than the latter group.

Conclusions These results suggest that cinacalcet may induce specific qualitative alterations of hyperplastic parathyroid glands in patients with severe SHPT.

  • Secondary hyperparathyroidism
  • cinacalcet hydrochloride
  • parathyroid gland
  • histopathological alteration
  • nephrology
  • parathyroid
  • histopathology
  • colorectal cancer
  • gall bladder
  • oncogenes
  • p53
  • pancreas
  • immunohistochemistry
  • renal

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  • Funding This study was partially funded by the Okinaka Memorial Institute for Medical Research and supported by a grant from The Kidney Foundation, Japan (JFKB 10-8).

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the ethical committee of Toranomon Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.