Abstract
Therapeutic failure of synthetic parathyroid hormone (teriparatide) in treatment of postsurgical hypoparathyroidism.It is presented a male patient with chronic renal failure and postsurgical hypoparathyroidism treated with calcitriol andcalcium carbonate in which renal transplant was practiced. Months later, he had severe hipocalcemia and hyperphosphatemiarefracting to high doses of calcitriol and calcium carbonate, opting to use of teriparatide, an aminoterminal fragment (1-34)synthetic of parathyroid hormone, with transient improvement. Then, the patient developed resistance to teriparatidedespite its use to non-conventional dose (120 μgs) making necessary its suspension and re-use high doses of calcitriol andcalcium carbonate to achieve stabilization. Hyperphosphatemia was treated subsequently with oral phosphate binders.
Keywords: Chronic renal failure. Hypoparathyroidism. Synthetic PTH. Teriparatide. Hypercalcemia.
References
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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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