Hypoparathyroidism: disease update

Abstract

Parathyroid hormone (PTH) is the main regulator of calcium and phosphorus metabolism. Insufficient levels of PTH or peripheral resistance to the hormone action lead to hypoparathyroidism characterized by low serum calcium and elevated serum phosphate levels. It is most commonlycaused by the inadvertent damage to the parathyroid glands during thyroid surgery. Patients with hypoparathyroidism are currently treated with oral calcium and active vitamin D. The standard treatment requires a balance between achieving acceptable serum calcium concentrations and normocalciuria. Worsening hypercalciuria is often underestimated because patients are at a substantial risk of chronic nephrocalcinosis and neprolithiasis. In fact, hypoparathyroidism is the last classical endocrine deficiency disease for which treatment with the missing hormone is not standard therapy. However,in 2015 FDA approved the recombinant human PTH(1-84) Natpara in combination with the oral calcium and active vitamin D for the hypoparathyroidism treatment. Replacement therapy with recombinant human PTH is a promising direction especially in the severe clinical cases, refractory to conventional therapy.

Keywords

• hypoparathyroidism, pseudohypoparathyroidism, parathyroid hormone (PTH), hypocalcemia, hyperphosphatemia, recombinant human PTH 1-84