Endocrine Abstracts

This study aims to evaluate patients who require PTH-treatment among the referral population with hypoparathyroidism.

Methods: The information was collected from the registry database of chronic hypoparathyroidism, which was initiated by the National Medical Research Centre for Endocrinology (NMRCE).

Results: Among 194 cases of hypoparathyroidism referred to our clinic over 2 years (2017–2019), eight patients required PTH replacement treatment and six patients (3,09%) received treatment with teriparatide due to complete resistance to conventional therapy with alfacalcidol and calcium supplementation. The mean age of these 6 patients at evaluation was 52 ± 12 s.d. years (minimum 31 and maximum 71 years); the female-to-male ratio was 5:1. In 4 cases the subjects had postsurgical hypoparathyroidism (in 3 cases after thyroid surgery (n = 2 thyroid cancer and n = 1 thyroid goiter) and in 1 case after parathyroid surgery). Additionally 1 patient had autoimmune polyglandular syndrome and one male patient suffered from idiopathic hypoparathyroidism. In 3 cases of postsurgical hypoparathyroidism patients suffered from osteoporosis diagnosed before thyroid or parathyroid surgery. The longest duration of teriparatide treatment was 5 years at a dose of 20–60 mg/day with periodically used pump therapy. Treatment with teriparatide was cancelled after achieving remission of candidiasis which led to improved gastrointestinal absorption. Other patients continued treatment with teriparatide. The next longest treatment duration was three years at a dose of 40 mg in a patient with gastric resection due to ulceration; 2.5 years at a dose of 20 mg in a patient with colon pseudomelanosis; one subject received 40 mg over 12 months and two patients only started treatment with teriparatide at a dose of 20 mg over 6 and 7 months. The daily dose of calcium and active vitamin D were reduced and calcium levels within the reference range were achieved in all subjects. Serum phosphate was decreased in 3 subjects out of 6. Bone mineral density (BMD) was increased in all patients with osteoporosis.

Conclusion: Severe malabsorption is the most frequent requirement of PTH treatment. Teriparatide was effective in all subjects to alleviate symptoms and to achieve calcium levels within the reference range.