How is hypoparathyroidism treated?

Unlike most other hormonal deficits, hypoparathyroidism is not treated with replacement of the missing hormone, parathyroid hormone (PTH).

Currently, the standard treatment for hypoparathyroidism consists of activated vitamin D (calcitriol) and calcium supplements. Some people may also need magnesium supplementation. Conventional therapy requires many pills taken throughout the day.1,2

Diet recommendations usually include eating foods high in calcium, such as dairy products, breakfast cereals, fortified orange juice, and green, leafy vegetables, or avoiding foods high in phosphorus, such as meat, poultry, fish, nuts, whole grains, and beans.3,4

Conventional therapy with vitamin D and calcium may lead to a buildup of calcium in the kidneys. This buildup may lead to problems, including kidney stones and deposits of calcium, reduced kidney function, tissue damage, or even kidney failure.

The development of PTH as a replacement therapy in patients with hypoparathyroidism was first explored by NICHD investigators beginning in 1992. Since then, NICHD researchers have conducted a series of classic studies evaluating PTH 1-34 regimens, including once-daily and twice-daily PTH injections without concurrent use of calcitriol or calcium supplements in adults and children. Recently, these NICHD researchers introduced PTH delivery by an insulin pump in two landmark studies in adults5 and in children.6,7,8,9,10 In January 2015, the U.S. Food and Drug Administration approved PTH 1-84 for adult hypoparathyroidism patients who do not respond well to standard treatment, as an add-on to that treatment.11

Citations

    1. National Library of Medicine. (2016). Hypoparathyroidism. Retrieved October 10, 2018, from http://www.nlm.nih.gov/medlineplus/ency/article/000385.htm
    2. Bollerslev, J., Rejnmark, L., Marcocci, C., Shoback, D. M., Sitges-Serra, A., van Biesen, W., & Dekkers, O. M.; European Society of Endocrinology. (2015). European Society of Endocrinology Clinical Guideline: Treatment of chronic hypoparathyroidism in adults. European Journal of Endocrinology, 173(2), G1–G20. Retrieved May 24, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/26160136
    3. Hormone Health Network (Endocrine Society). (2018). Hypoparathyroidism. Retrieved October 2, 2018, from https://www.hormone.org/diseases-and-conditions/bone-health/hypoparathyroidism  
    4. U.S. Department of Agriculture. (2018). Non-dairy sources of calcium. Retrieved May 29, 2019, from https://www.choosemyplate.gov/dairy-calcium-sources
    5. Winer, K. K., Zhang, B., Shrader, J. A., Peterson, D., Smith, M., Albert, P. S., & Cutler, G. B. Jr. (2012). Synthetic human parathyroid hormone 1-34 replacement therapy: A randomized crossover trial comparing pump versus injections in the treatment of chronic hypoparathyroidism. Journal of Clinical Endocrinology and Metabolism, 97(2), 391–399. Retrieved May 3, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/22090268
    6. Winer, K. K., Fulton, K. A., Albert, P. S., & Cutler, G. B. Jr. (2014). Effects of pump versus twice-daily injection delivery of synthetic parathyroid hormone 1-34 in children with severe congenital hypoparathyroidism. Journal of Pediatrics, 165(3), 556–563.e1. Retrieved May 3, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/24948345
    7. Winer, K. K. (2019). Advances in the treatment of hypoparathyroidism with PTH 1-34. Bone, 120, 535–541. Retrieved March 19, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/30243992
    8. Saraff, V., Rothenbuhler, A., Högler, W., & Linglart, A. (2018). Continuous subcutaneous recombinant parathyroid hormone (1-34) infusion in the management of childhood hypoparathyroidism associated with malabsorption. Hormone Research in Paediatrics, 89(4), 271–277. Retrieved May 24, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/28926829
    9. Mannstadt, M., Clarke, B. L., Vokes, T., Brandi, M. L., Ranganath, L., Fraser, W. D., et al. (2013). Efficacy and safety of recombinant human parathyroid hormone (1-84) in hypoparathyroidism (REPLACE): A double-blind, placebo-controlled, randomised phase 3 study. The Lancet Diabetes & Endocrinology, 1(4), 275–283. Retrieved May 24, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/24622413
    10. Rejnmark, L., Sikjaer, T., Underbjerg, L., & Mosekilde, L. (2013). PTH replacement therapy of hypoparathyroidism. Osteoporosis International, 24(5), 1529–1536. Retrieved May 24, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/23184178
    11. U.S. Food and Drug Administration. (2018). Novel drug approvals for 2015. Retrieved May 28, 2019, from https://www.fda.gov/drugs/new-drugs-fda-cders-new-molecular-entities-and-new-therapeutic-biological-products/novel-drug-approvals-2015
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