Fuss Carmina Teresa, Burger-Stritt Stephanie, Horn Silke, Koschker Ann-Cathrin, Frey Kathrin, Meyer Almuth, Hahner Stefanie
Division of Endocrinology and Diabetology, Department of Medicine I, University Hospital Würzburg, Würzburg, Germany.
Division of Endocrinology and Diabetology, Department of Internal Medicine, Helios Klinikum Erfurt, Erfurt, Germany.
Endocrinol Diabetes Metab Case Rep. 2020 May 29;2020. doi: 10.1530/EDM-20-0009.
Standard treatment of hypoparathyroidism consists of supplementation of calcium and vitamin D analogues, which does not fully restore calcium homeostasis. In some patients, hypoparathyroidism is refractory to standard treatment with persistent low serum calcium levels and associated clinical complications. Here, we report on three patients (58-year-old male, 52-year-old female, and 48-year-old female) suffering from severe treatment-refractory postsurgical hypoparathyroidism. Two patients had persistent hypocalcemia despite oral treatment with up to 4 µg calcitriol and up to 4 g calcium per day necessitating additional i.v. administration of calcium gluconate 2-3 times per week, whereas the third patient presented with high frequencies of hypocalcemic and treatment-associated hypercalcemic episodes. S.c. administration of rhPTH (1-34) twice daily (40 µg/day) or rhPTH (1-84) (100 µg/day) only temporarily increased serum calcium levels but did not lead to long-term stabilization. In all three cases, treatment with rhPTH (1-34) as continuous s.c. infusion via insulin pump was initiated. Normalization of serum calcium and serum phosphate levels was observed within 1 week at daily 1-34 parathyroid hormone doses of 15 µg to 29.4 µg. Oral vitamin D and calcium treatment could be stopped or reduced and regular i.v. calcium administration was no more necessary. Ongoing efficacy of this treatment has been documented for up to 7 years so far. Therefore, we conclude that hypoparathyroidism that is refractory to both conventional treatment and s.c. parathyroid hormone (single or twice daily) may be successfully treated with continuous parathyroid hormone administration via insulin pump.
Standard treatment of hypoparathyroidism still consists of administration of calcium and active vitamin D. Very few patients with hypoparathyroidism also do not respond sufficiently to standard treatment or administration of s.c. parathyroid hormone once or twice daily. In those cases, continuous s.c. administration of parathyroid hormone via insulin pump may represent a successful treatment alternative.
甲状旁腺功能减退症的标准治疗包括补充钙和维生素D类似物，但这并不能完全恢复钙稳态。在一些患者中，甲状旁腺功能减退症对标准治疗无效，血清钙水平持续偏低并伴有相关临床并发症。在此，我们报告3例（1例58岁男性、2例女性，分别为52岁和48岁）患有严重的术后难治性甲状旁腺功能减退症的患者。2例患者尽管口服高达4μg骨化三醇和每日高达4g钙进行治疗，但仍持续存在低钙血症，需要每周额外静脉注射葡萄糖酸钙2 - 3次，而第3例患者出现低钙血症和治疗相关高钙血症发作的频率较高。皮下注射重组人甲状旁腺激素（1 - 34）每日2次（40μg/天）或重组人甲状旁腺激素（1 - 84）（100μg/天）仅使血清钙水平暂时升高，但未导致长期稳定。在所有3例病例中，均开始通过胰岛素泵持续皮下注射重组人甲状旁腺激素（1 - 34）进行治疗。在每日1 - 34甲状旁腺激素剂量为15μg至29.4μg的情况下，1周内观察到血清钙和血清磷水平恢复正常。口服维生素D和钙治疗可以停止或减少，不再需要定期静脉注射钙。到目前为止，这种治疗的持续疗效已被记录长达7年。因此，我们得出结论，对传统治疗和皮下注射甲状旁腺激素（每日1次或2次）均难治的甲状旁腺功能减退症，通过胰岛素泵持续注射甲状旁腺激素可能是一种成功的治疗方法。
甲状旁腺功能减退症的标准治疗仍然是给予钙和活性维生素D。极少数甲状旁腺功能减退症患者对标准治疗或每日1次或2次皮下注射甲状旁腺激素也反应不佳。在这些情况下，通过胰岛素泵持续皮下注射甲状旁腺激素可能是一种成功的治疗选择。
