Endocrine Abstracts

Hypoparathyroidism is, in Italy, an orphan disease because the hormonal replacement therapy is possible only with teriparatide (fragment 1–34 of of human parathyroid hormone). Otherwise the patients use oral calcium and calcitriol. This scheme of therapy obtained correct plasmatic calcium and phosphate levels, correct urinary excretion of calcium and phosphate, adequate quality of life – QoL only in a little percentage of patients. Especially kidney stones, intra-renal calcifications, chronic kidney disease are too frequent during this “conventional” therapy. Recently, Italian Agency of drug approved the use of recombinant human parathyroid hormone (rhPTH) for chronic hypoparathyroidism, but only on payment. Long-term studies on rhPTH(1–84) replacement therapy, up to 6 years, demonstrated prolonged efficacy of this drug, with persistent normal plasmatic and urinary levels of calcium and phosphate, reduced renal complications, high QoL. We have given teriparatide at the started dose of 20 mcg twice, to four hypoparathyroid patients (all women, post-surgical, after an unsuccessful period of “conventional” therapy characterized by frequent accesses in emergency for hypolcalcemic crisis notwithstanding high levels of oral calcium and calcitriol) for six (one patient) or eight years (three patients), monitoring plasmatic and urinary biochemical levels, renal ultrasounds, femoral and lumbar densitometry, questionnarie for QoL. All patients quickly obtained increased plasmatic calcium levels, despite reduction or interruption of calcium and calcitriol supplementation; no one had hypocalcemic crisis: three of them normalized plasmatic calcium levels and one had to stop teriparatide for hypercalcaemia. One patient had persistent low values of serum calcium (even though higher than in conventional therapy), but without hypocalcemic crisis and a persistent well-being feeling. Plasmatic phosphate levels decreased up to normal, as urinary excretion of calcium and phosphate. No other biochemical parameter was significantly modified. No patient developed urinary complications. No-one is in therapy with bone active drugs for osteoporosis. We also administered, at baseline, at 6 and 24 months and at the end of study, the RAND 36-Item Short Form (SF-36) Health Survey, covering eight domains of physical and mental health, to evaluate their perception of QoL before and during therapy with teriparatide. Data showed a significant improvement in the mean scores of all eight domains, especially during the first two years of therapy. We can conclude that the treatment with teriparatide in post-surgical hypoparathyroidism is effective and safe in improving mental and physical health of patients, also in a prolonged period of therapy.