Brief Answer:
PHPT

Detailed Answer:
1. Is the dosage fixed or can we reduce the dosage?
The usual starting dose of cinacalcet for PHPT is 30 mg twice daily, although I do see you are taking it once daily. I agree your calcium has normalized but I would emphasize you consult an Endocrinologist personally to 100% ascertain the diagnosis before you go any further.

2. Is there a danger of going into hypocalcemia ? If so how to monitor or Prevent this ?
Yes, the risk varies from 6% to 75%. There are several ways to prevent this. Couple examples include having adequate calcium and vitamin D in diet , and monitoring blood calcium levels periodically

3. If I undergo surgery,how many days before surgery should I stop using it
There is no specific answer to this. Your calcium levels prior to starting Cinacalcet seem only mildly elevated, if at all (because you have not mentioned upper limit of normal for calcium in your laboratory report). This is not an emergency , so it does not matter when you stop. More importantly, once the diagnosis certain, and surgery is planned, it can be scheduled electively.

and how do they judge the Severity of my disease ?
Typically, blood calcium levels are used to categorize the problem as mild, moderate to severe

4. What are incidences Of Complications of surgery
0.3% to 5%
Are they common ? above percentage shows it is uncommon

5. How long is the surgery and how long should I stay in hospital
again, if you truly have PHPT, then the next step is to determine the cause of it. Surgery is typically the option for over-active parathyroid glands called adenomas.
If you have only one parathyroid adenoma and a 'minimally invasive radio-guided' approach is used by an experienced surgeon, then you can go home the same day after the surgical procedure

6. How Do they prevent postoperative hypocalcemia
The same approach as explained above ......ensure adequacy of calcium and vitamin D in diet. Calcium supplements are typically prescribed. If a blood test for 25 hydroxy Vitamin D is low, then it is also replaced with supplements.

7.based on my original calcium level of 10.2 mg Do u think my disease is mild ?
Yes

8. What is the severity of my disease
Mild.

But first you need a thorough evaluation by an endocrinologist to confirm PHPT, before attempts are made to classify the severity

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Brief Answer:
Follow up

Detailed Answer:
Ok I see.

1 Calcium supplements can be avoided as long your calcium intake from diet is about 1000 mg daily. I know it may seem paradoxical that one is advised to do this in the face of a disorder that raises blood calcium, and as you asked, while taking cinacalcet but evidence is strongly in favor of this. It does not oppose the effect of cinacalcet. In fact, not taking adequate calcium in diet can worsen problems.

2 Some examples of how to replenish your bone are :

a) adequate amounts of calcium in diet

b) adequate amounts of (25 hydroxy) Vitamin D in blood

c) Treating the PHPT correctly

These will also reduce your risk of fracture.

3 No it is not common. It is likely due to your PHPT

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Brief Answer:
Second follow up

Detailed Answer:
1 Yes, but only if your diet in insufficient in calcium. It is preferable to obtain your daily calcium requirement of around 1000 mg through diet. You may wish to consult a dietitian on how to achieve this.

2 Yes, even though it may seem paradoxical that calcium must be takin in normal daily amounts in the face of a disorder which causes high blood calcium. However, the same principle as in above paragraph applies here. Avoid supplements if you can derive the necessary calcium intake from dietary sources

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