Cinacalcet and Parathyroidectomy Outcomes in Symptomatic and Asymptomatic Primary Hyperparathyroidism: A Retrospective Observational Study.

INTRODUCTION: Primary hyperparathyroidism (PHPT) is a common and symptomatic endocrine disorder in India. There has been a notable rise in asymptomatic PHPT (urban India), creating a dilemma in optimal treatment approach-surgery or medical management. Cinacalcet is a calcimimetic used in managing PHPT, but data regarding its use from India is limited. This retrospective study aimed to assess the prevalence of asymptomatic PHPT, compare symptomatic versus asymptomatic PHPT and evaluate the real-world outcomes among patients managed with parathyroidectomy (PTX) or cinacalcet. METHODS: A retrospective analysis was conducted on 90 PHPT patients seen between January 2020 and July 2024 at a tertiary care centre in New Delhi, India. Clinical, biochemical and imaging data were collected, and real-world outcomes were assessed for PTX and cinacalcet. Statistical analysis was performed using SPSS. RESULTS: Of the 90 patients, 64.4% were symptomatic and 35.6% were asymptomatic. Symptomatic patients had higher parathyroid hormone (PTH) levels and more frequent MIBI localization. PTX was curative and led to significantly greater reductions in calcium (P = 0.006) and PTH (P = 0.009). Conversely, cinacalcet use was associated with normalization of calcium (P = 0.001) and lowering of PTH (P = 0.001) in both symptomatic and asymptomatic patients, with minimal side effects. CONCLUSION: A significant proportion of cases were asymptomatic PHPT, with biochemical and radiological profiles closely resembling those of symptomatic cases. While PTX provided definitive cure, cinacalcet led to short-term normalization of calcium and reduction of PTH. Cinacalcet serves as an alternative for patients who refuse surgery, are not candidates for surgery, or prefer medical management.