Primary Hyperparathyroidism in MEN1 — When Surgery Is Not an Immediate Option

MEN1-related primary hyperparathyroidism is a key manifestation of Multiple endocrine neoplasia type 1. When surgery is not immediately feasible — because a patient is not a candidate or is currently awaiting the procedure — medical management is required to control biochemical abnormalities in the interim.

Clinical Situation

This protocol addresses patients with primary hyperparathyroidism in the context of MEN1 who are not candidates for (re-operative) surgery, or who are awaiting surgery. The clinical priority is to reduce or normalise elevated serum calcium and parathyroid hormone concentrations.

Treatment Approach

The approach centres on a calcimimetic agent — a class of drug that targets the calcium-sensing receptor — to bring serum calcium and PTH toward normal range. Specific selection, monitoring guidance, and full sequencing details are held in the complete protocol.

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References

DOI: 10.1016/S2213-8587(25)00119-6

The calcimimetic drug, cinacalcet, which is a positive allosteric modulator of the calcium-sensing receptor, can be used to reduce or normalise serum calcium and PTH concentrations in patients who are not candidates for (re-operative) surgery or are awaiting surgery.

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