Opioid Receptor hypocalcemia, or suffered an adverse reaction attributable to the drug. In patients with adverse reactions and suspected noncompliance, the drug was withdrawn. Patients continued to receive their previously prescribed therapy for 2HPTH in the form of calcium supplements, phosphate binders, and vitamin D during the study period. Changes in the dose and type of drugs prescribed were not restricted and were performed at the physicians discretion. The PTH, calcium, phosphate, and alkaline phosphatase were routinely monitored at monthly intervals. The average duration of follow up was 18 6 6 months. Categorical variables are presented as a percentage and continuous variables as mean 6 SE in texts and tables. Statistical significance of the continuous variables was assessed by application of the t test for paired and unpaired samples within and between cohorts. Wilcoxon signed rank test and Fisher exact test were used for comparative analysis of nonparametric and nominal data. The statistical S1P Receptors analysis was performed by using JMP version 6. P\.05 was considered statistically significant. Results From a total of 54 patients studied, 20 underwent surgical intervention.
Eighteen total parathyroidectomies withoutautotransplantation and 2 total Hedgehog Pathwy parathyroidectomies with autotransplantation were performed. Thyroid lobectomy was performed in 1 patient as a consequence of the hyperplastic parathyroid gland being embedded in the substance of the thyroid tissue. In comparison, 34 patients were prescribed cinacalcet in renal outpatient clinics, the most commonly prescribed dose was 30 mg on a oncedaily basis. Comparison of Baseline Demographics and Bone Profile There was no statistically significant difference between the average 12 month preintervention control of PTH, calcium, phosphate, Ca 3 P product, and ALP between the patients receiving cinacalcet and those undergoing surgery. All patients studied were on phosphate binders, and more than 90% from each intervention group were on vitamin D sterols with little difference between the groups on type of agent being prescribed. Comparing Changes in PTH In patients who underwent Vinorelbine surgical intervention, the mean PTH level before surgery was 1537 ng/dL, which decreased to a mean PTH of 46 ng/dL with a percentage reduction of more than 97% in the first week postoperatively. After 18 months, the average PTH was 55.5 ng/dL, with an average 96% reduction.
Ninety percent of patients achieved a PTH\300 ng/dL, and 100% of patients achieved a percentage reduction of.40% from baseline PTH. The percentage reduction varied from 77% to 98% with a mean reduction of 96%. In comparison, in patients treated with cinacalcet, baseline mean PTH levels were 1235 ng/dL, and by 18 months of treatment with cinacalcet, this decreased to a mean of 642 ng/dL, with a mean percentage symptomatic reduction of 48%. Twenty six percent of patients achieved a PTH \300 ng/dL, and 42% of patients achieved a percentage reduction of.40% from baseline PTH. The percentage reduction varied from 6% to 89%, with a mean reduction of 50% over 18 months. The surgical cohort of patients had a more significant reduction in PTH from baseline compared with the cinacalcet cohort. Forty five percent of patients managed with surgery had a PTH within the reference range.