CEN Case Reports

, Volume 7, Issue 1, pp 21–23 | Cite as

Hungry bone syndrome two weeks after starting cinacalcet: a call for caution

  • Sahar H. Koubar
  • Abd Assalam Qannus
  • Walid Medawar
  • Ali K. Abu-Alfa
Case Report


Cinacalcet is an effective and safe alternative to parathyroidectomy in end stage renal disease (ESRD) patients with secondary hyperparathyroidism. Hypocalcemia is a known complication of treatment that is usually readily reversible upon discontinuation of the drug. It rarely manifests severely and symptomatically requiring hospital admission. We present the case of a 55 year old man with severe, symptomatic and prolonged hypocalcemia that occurred 2 weeks after starting cinacalcet. Cinacalcet induced a state of pharmacological parathyroidectomy with subsequent hungry bone syndrome. Serum calcium returned to normal range after 4 weeks of stopping the drug while receiving high doses of elemental calcium and vitamin D receptor activation therapy (VDRA).


Hypocalcemia Secondary hyperparathyroidism Cinacalcet Hungry bone syndrome 


Compliance with ethical standards

Conflict of interest

Dr. Ali Abu-Alfa has consulted for Amgen in the past 12 months. The rest of the authors report no conflict of interest.

Research involving human participants/animals

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

An informed consent was obtained from the patient reported.


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Copyright information

© Japanese Society of Nephrology 2017

Authors and Affiliations

  • Sahar H. Koubar
    • 1
  • Abd Assalam Qannus
    • 2
  • Walid Medawar
    • 1
  • Ali K. Abu-Alfa
    • 1
  1. 1.Division of Nephrology, Department of Internal MedicineAmerican University of BeirutBeirutLebanon
  2. 2.Division of Nephrology, Department of Internal MedicineMaine Medical CenterMaineUSA

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