Management of Hypoparathyroidism: Present and Future
- 1 June 2016
- journal article
- review article
- Published by The Endocrine Society in Journal of Clinical Endocrinology & Metabolism
- Vol. 101 (6), 2313-2324
- https://doi.org/10.1210/jc.2015-3910
Abstract
Context: Conventional management of hypoparathyroidism has focused upon maintaining the serum calcium with oral calcium and active vitamin D, often requiring high doses and giving rise to concerns about long-term consequences including renal and brain calcifications. Replacement therapy with PTH has recently become available. This paper summarizes the results of the findings and recommendations of the Working Group on Management of Hypoparathyroidism. Evidence Acquisition: Contributing authors reviewed the literature regarding physiology, pathophysiology, and nutritional aspects of hypoparathyroidism, management of acute hypocalcemia, clinical aspects of chronic management, and replacement therapy of hypoparathyroidism with PTH peptides. PubMed and other literature search engines were utilized. Evidence synthesis: Under normal circumstances, interactions between PTH and active vitamin D along with the dynamics of calcium and phosphorus absorption, renal tubular handing of those ions, and skeletal responsiveness help to maintain calcium homeostasis and skeletal health. In the absence of PTH, the gastrointestinal tract, kidneys, and skeleton are all affected, leading to hypocalcemia, hyperphosphatemia, reduced bone remodeling, and an inability to conserve filtered calcium. Acute hypocalcemia can be a medical emergency presenting with neuromuscular irritability. The recent availability of recombinant human PTH (1–84) has given hope that management of hypoparathyroidism with the missing hormone in this disorder will provide better control and reduced needs for calcium and vitamin D. Conclusions: Hypoparathyroidism is associated with abnormal calcium and skeletal homeostasis. Control with calcium and active vitamin D can be a challenge. The availability of PTH (1–84) replacement therapy may usher new opportunities for better control with reduced supplementation requirements.Keywords
This publication has 89 references indexed in Scilit:
- CorrigendaJournal of Clinical Endocrinology & Metabolism, 2015
- Magnesium Supplementation Does Not Affect Blood Calcium Level in Treated Hypoparathyroid PatientsJournal of Clinical Endocrinology & Metabolism, 2012
- The US postmarketing surveillance study of adult osteosarcoma and teriparatide: Study design and findings from the first 7 yearsJournal of Bone and Mineral Research, 2012
- Vitamin D and intestinal calcium absorptionMolecular and Cellular Endocrinology, 2011
- Hypoparathyroidism in the adult: Epidemiology, diagnosis, pathophysiology, target-organ involvement, treatment, and challenges for future researchJournal of Bone and Mineral Research, 2011
- Long-Term Treatment of 12 Children with Chronic Hypoparathyroidism: A Randomized Trial Comparing Synthetic Human Parathyroid Hormone 1-34 versus Calcitriol and CalciumJournal of Clinical Endocrinology & Metabolism, 2010
- Therapy of hypoparathyroidism with intact parathyroid hormoneOsteoporosis International, 2010
- Diagnosis and management of hypocalcaemiaBMJ, 2008
- Vitamin D2 Is as Effective as Vitamin D3 in Maintaining Circulating Concentrations of 25-Hydroxyvitamin DJournal of Clinical Endocrinology & Metabolism, 2008
- Vitamin D DeficiencyThe New England Journal of Medicine, 2007