Cómo citar
Restrepo-Valencia, C. A., & Manjarres-Iglesias, G. (2011). Fracaso de la hormona sintética paratiroidea (teriparatida) en el tratamiento del hipoparatiroidismo posquirúrgico. Médicas UIS, 24(1). Recuperado a partir de https://revistas.uis.edu.co/index.php/revistamedicasuis/article/view/2585
Resumen
Se presenta un paciente con enfermedad renal crónica e hipoparatiroidismo posquirúrgico tratado con calcitriol y carbonatocálcico, a quien se le practicó trasplante renal. Meses más tarde revela hipocalcemia severa con hiperfosfatemia refractariaa altas dosis de calcitriol y carbonato cálcico, optándose por utilizar teriparatida un fragmento aminoterminal (1-34) sintéticode la paratohormona, con mejoría transitoria. Luego desarrolla resistencia a la misma a pesar de su utilización a dosis noconvencionales (120 μgs/día), siendo necesaria su suspensión y el uso de nuevo de dosis muy altas de calcitriol y carbonatocálcico para lograr estabilización. La hiperfosfatemia desencadenada fue manejada posteriormente con quelantes de fosfatosvía oral.
Palabras clave: Enfermedad renal crónica. Hipoparatiroidismo. PTH sintética. Teriparatida. Hipercalcemia.
Referencias
1. Koeppen BM, Stanton BA. Regulation of calcium and phosphate homeostasis. In: Koeppen B M, Stanton B A, editors. Renal Physiology. Fourth Edition. Philadelphia. 2007.p.149-61.
2. Cesar A, Restrepo V. Desordenesoseos y minerales en la enfermedad renal crónica. In: Cesar A Restrepo, editor. Nefrología Básica. Manizales: La patria. 2007.p.129-33.
3. Shoback D. Hypoparathyroidism. N Engl J Med. 2008;359:391-403.
4. Marx S J. Hyperparathyroid and hypoparathyroid disorders. N Engl J Med. 2000;343:1863-75.
5. Harris V W, De Beur S J. Postoperative hypoparathyroidism: medical and surgical therapeutic options. Thyroid. 2009;19:967-73.
6. Torregrosa NM, Rodríguez JM, Llorente S, Balsalobre MD, Rios A, Jimeno L, Parrilla P.
7. Definitive Treatment for Persistent Hypoparathyroidism in a Kidney Transplant Patient: Parathyroid Allotransplantation. Thyroid. 2005;15:1299-302.
8. Page C, Strunski V. Parathyroid risk in total thyroidectomy for bilateral benign, multinodular goiter: report of 351 surgical cases. J LaryngolOtol. 2007;121:237-41.
9. Jeon JH, Puleo DA. Formulations for Intermittent Release of Parathyroid Hormone (1-34) and Local Enhancement of Osteoblast Activities. Pharm DevTechnol. 2008;13:505–12.
10. Winer KK, Yanovski J A, Cutler G B. Synthetic human parathyroid hormone 1-34 vscalcitriol and calcium in the treatment of hypoparathyroidism. Jama. 1996;276:631-6.
11. Winer KK ,Ko CW, Reynolds JC, Dowdy K, Keil M, Peterson D. et al. Long-Term Treatment of Hypoparathyroidism: A Randomized Controlled Study Comparing Parathyroid Hormone-(1–34) Versus Calcitriol and Calcium. J ClinEndocrinol Metab. 2003;88:4214–20.
12. Vahle JL, Long GG, Sandusky G, Westmore M, Ma YL, Sato M. Boneneoplasms in F344 ratsgiventeriparatide [rhPTH(1-34)] are dependentonduration of treatment and dose. ToxicolPathol. 2004;32:426-38.
13. Winer KK, Yanovski J A, SaranI B, Cutler G B. A Randomized, Cross-Over Trial of Once-Daily VersusTwice-Daily Parathyroid Hormone 1–34 in Treatment of Hypoparathyroidism. J ClinEndocrinolMetab. 1998;83:3480–6.
14. Winer K K, Sinaii N, Peterson D, Sainz B, Cutler G B. Effects of Once Versus Twice-Daily Parathyroid Hormone 1–34 Therapy in Children with Hypoparathyroidism. J ClinEndocrinolMetab. 2008;93:3389–95.
15. Angelopoulos N G, Goula A, Tolis G. Sporadic Hypoparathyroidism Treated with Teriparatide: A Case Report and Literature Review. ExpClinEndocrinol Diabetes. 2007;115:50–4.
16. Sanda S, Schlingmann K P, Newfield R S. Autosomal dominant hypoparathyroidism with severe hypomagnesemia and hypocalcemia, successfully treated with recombinant PTH and continuous subcutaneous magnesium infusion. J PediatrEndocrinolMetab. 2008;21:385-91.
17. Mahajan A, Narayanan M, Jaffers G, Concepcion L. Hypoparathyroidism associated with severe mineral bone disease postrenal transplantation, treated successfully with recombinant PTH. HemodialInt. 2009;13:547–50.
18. Rubin MR, Sliney J, McMahon DJ, Silverberg S SJ, Bilezikian JP. Therapy of hypoparathyroidism with intact parathyroid hormone. OsteoporosInt DOI 10.1007/s00198-009-1149-x, published online 22 january 2010.
19. Chu NN, Li XN, Chen WL, H. Xu HR. Pharmacokinetics and safety of recombinant human parathyroid hormone (1-34) (teriparatide) after single ascending doses in Chinese healthy volunteers. Pharmazie. 2007;62:869–71.
20. Puig-Domingo M, Diaz G, Nicolau J, Fernandez C, Rueda S, Halperin I. Successful treatment of vitamin D unresponsive hypoparathyroidism with multipulse subcutaneous infusion of teriparatide. Eur J Endocrinol. 2008;159:653–7.
21. Konrad M, Weber S. Recent Advances in Molecular Genetics of Hereditary Magnesium-Losing Disorders. J Am SocNephrol. 2003;14:249–60.
2. Cesar A, Restrepo V. Desordenesoseos y minerales en la enfermedad renal crónica. In: Cesar A Restrepo, editor. Nefrología Básica. Manizales: La patria. 2007.p.129-33.
3. Shoback D. Hypoparathyroidism. N Engl J Med. 2008;359:391-403.
4. Marx S J. Hyperparathyroid and hypoparathyroid disorders. N Engl J Med. 2000;343:1863-75.
5. Harris V W, De Beur S J. Postoperative hypoparathyroidism: medical and surgical therapeutic options. Thyroid. 2009;19:967-73.
6. Torregrosa NM, Rodríguez JM, Llorente S, Balsalobre MD, Rios A, Jimeno L, Parrilla P.
7. Definitive Treatment for Persistent Hypoparathyroidism in a Kidney Transplant Patient: Parathyroid Allotransplantation. Thyroid. 2005;15:1299-302.
8. Page C, Strunski V. Parathyroid risk in total thyroidectomy for bilateral benign, multinodular goiter: report of 351 surgical cases. J LaryngolOtol. 2007;121:237-41.
9. Jeon JH, Puleo DA. Formulations for Intermittent Release of Parathyroid Hormone (1-34) and Local Enhancement of Osteoblast Activities. Pharm DevTechnol. 2008;13:505–12.
10. Winer KK, Yanovski J A, Cutler G B. Synthetic human parathyroid hormone 1-34 vscalcitriol and calcium in the treatment of hypoparathyroidism. Jama. 1996;276:631-6.
11. Winer KK ,Ko CW, Reynolds JC, Dowdy K, Keil M, Peterson D. et al. Long-Term Treatment of Hypoparathyroidism: A Randomized Controlled Study Comparing Parathyroid Hormone-(1–34) Versus Calcitriol and Calcium. J ClinEndocrinol Metab. 2003;88:4214–20.
12. Vahle JL, Long GG, Sandusky G, Westmore M, Ma YL, Sato M. Boneneoplasms in F344 ratsgiventeriparatide [rhPTH(1-34)] are dependentonduration of treatment and dose. ToxicolPathol. 2004;32:426-38.
13. Winer KK, Yanovski J A, SaranI B, Cutler G B. A Randomized, Cross-Over Trial of Once-Daily VersusTwice-Daily Parathyroid Hormone 1–34 in Treatment of Hypoparathyroidism. J ClinEndocrinolMetab. 1998;83:3480–6.
14. Winer K K, Sinaii N, Peterson D, Sainz B, Cutler G B. Effects of Once Versus Twice-Daily Parathyroid Hormone 1–34 Therapy in Children with Hypoparathyroidism. J ClinEndocrinolMetab. 2008;93:3389–95.
15. Angelopoulos N G, Goula A, Tolis G. Sporadic Hypoparathyroidism Treated with Teriparatide: A Case Report and Literature Review. ExpClinEndocrinol Diabetes. 2007;115:50–4.
16. Sanda S, Schlingmann K P, Newfield R S. Autosomal dominant hypoparathyroidism with severe hypomagnesemia and hypocalcemia, successfully treated with recombinant PTH and continuous subcutaneous magnesium infusion. J PediatrEndocrinolMetab. 2008;21:385-91.
17. Mahajan A, Narayanan M, Jaffers G, Concepcion L. Hypoparathyroidism associated with severe mineral bone disease postrenal transplantation, treated successfully with recombinant PTH. HemodialInt. 2009;13:547–50.
18. Rubin MR, Sliney J, McMahon DJ, Silverberg S SJ, Bilezikian JP. Therapy of hypoparathyroidism with intact parathyroid hormone. OsteoporosInt DOI 10.1007/s00198-009-1149-x, published online 22 january 2010.
19. Chu NN, Li XN, Chen WL, H. Xu HR. Pharmacokinetics and safety of recombinant human parathyroid hormone (1-34) (teriparatide) after single ascending doses in Chinese healthy volunteers. Pharmazie. 2007;62:869–71.
20. Puig-Domingo M, Diaz G, Nicolau J, Fernandez C, Rueda S, Halperin I. Successful treatment of vitamin D unresponsive hypoparathyroidism with multipulse subcutaneous infusion of teriparatide. Eur J Endocrinol. 2008;159:653–7.
21. Konrad M, Weber S. Recent Advances in Molecular Genetics of Hereditary Magnesium-Losing Disorders. J Am SocNephrol. 2003;14:249–60.
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