case_images: PMC3934321_01
case_images: Plasma levels of PTH, ionized-calcium (Figure 1(a)), and phosphate (Figure 1(b)) three years before initiation of cinacalcet treatment and during the three years of cinacalcet treatment. Start of cinacalcet treatment, as indicated by the vertical line, was March 2010. Top bars show dosage of medical treatment. CaD; calcium carbonate 250 mg with 30 mug/d (1200 IU) of cholecalciferol. Reference intervals of plasma PTH (1.6-6.9 pmol/L) are indicated by the lower grey area and plasma Ca2+ (1.18-1.32 mmol/L) by the upper grey area. Measurements of ionized calcium (Ca2+) were not available prior to May 2008 (Figure 1(a)). The reference interval of plasma phosphate was 0.76-1.41 mmol/L, as indicated by the grey area (Figure 1(b)).
case_images: CRIM.ENDOCRINOLOGY2014-479641.001.jpg
case_images: PMC3934321_01_CRIM.ENDOCRINOLOGY2014-479641.001.jpg
case_images: fig1
case_images: Thirty mg of cinacalcet was added to her treatment as displayed in Figure 1. An attempt at increasing dosage to 60 mg was abandoned because of a fall in plasma calcium (October 2010, Figure 1(a)). PTH levels that endured until dosage of cinacalcet was adjusted at 30 mg per day (May 2013). Plasma phosphate was on average unchanged after addition of cinacalcet (Figure 1(b)). Plasma calcium was lower than prior to cinacalcet treatment but the patient did not experience hypocalcemic symptoms, and treatment was well tolerated without complaints of adverse effects (see Table 1).
case_images: Plasma levels of alkaline phosphatase three years before initiation of cinacalcet treatment and during the three years of cinacalcet treatment. Start of cinacalcet treatment, as indicated by the vertical line, was March 2010. Top bars show dosage of medical treatment. CaD; calcium carbonate 250 mg with 30 mug/d (1200 IU) of cholecalciferol. The reference interval of plasma alkaline phosphatase was 35-105 U/L as indicated by the grey area.
case_images: CRIM.ENDOCRINOLOGY2014-479641.002.jpg
case_images: PMC3934321_01_CRIM.ENDOCRINOLOGY2014-479641.002.jpg
case_images: fig2
case_images: Following start of treatment with cinacalcet, plasma levels of alkaline phosphatase (ALP) rose significantly but stabilized (Figure 2).