Angelopoulos N G, Goula A, Tolis G
Endocrinology and Metabolism, Hippocratio Hospital, Athens, Greece.
Exp Clin Endocrinol Diabetes. 2007 Jan;115(1):50-4. doi: 10.1055/s-2007-967088.
Herein we describe the case of a 64-year-old woman with hypoparathyroidism diagnosed at the age of 40, after an acute episode of tetany and seizures due to severe hypocalcemia. She was treated for more than 20 years with calcitriol and calcium supplementation but she presented with marked hypercalciuria and recently nephrolithiasis, although serum calcium was maintained at levels below normal range. Provided that any attempt to increase the recommended dose of calcitriol was leading to an exacerbation of hypercalciuria, we decided to enroll an alternative tool in the treatment strategy. In order to avoid further deterioration of renal function she was administered once-daily a subcutaneous (sc) injection of synthetic human parathyroid hormone (PTH 1-34) while doses of calcium and calcitriol were gradually decreased depending on the response of calcium metabolism in serum and urine samples taken periodically. Within two months of administration, PTH (1-34) significantly reduced the level of urine calcium excretion compared with calcitriol therapy and maintained serum calcium in the normal range. The relevant literature is reviewed in light of this alternative therapeutic approach in long-standing hypoparathyroidism, illustrating the potential benefits and the unresolved issues in parathyroid hormone replacement.
在此，我们描述了一名64岁女性的病例，她在40岁时因严重低钙血症引发手足抽搐和癫痫急性发作后被诊断为甲状旁腺功能减退症。她接受骨化三醇和钙剂补充治疗超过20年，但尽管血清钙维持在低于正常范围的水平，她仍出现明显的高钙尿症，最近还患上了肾结石。鉴于任何增加骨化三醇推荐剂量的尝试都会导致高钙尿症加重，我们决定在治疗策略中采用一种替代方法。为避免肾功能进一步恶化，我们每天给她皮下注射一次合成人甲状旁腺激素（PTH 1-34），同时根据定期采集的血清和尿液样本中钙代谢的反应，逐渐减少钙剂和骨化三醇的剂量。在给药后的两个月内，与骨化三醇治疗相比，PTH（1-34）显著降低了尿钙排泄水平，并将血清钙维持在正常范围内。我们根据这种治疗长期甲状旁腺功能减退症的替代方法对相关文献进行了综述，阐述了甲状旁腺激素替代治疗的潜在益处和未解决的问题。
