Khan Aliya A, Guyatt Gordon, Ali Dalal S, Bilezikian John P, Collins Michael T, Dandurand Karel, Mannstadt Michael, Murphy Deborah, M'Hiri Iman, Rubin Mishaela R, Sanders Robert, Shrayyef Muhammad, Siggelkow Heide, Tabacco Gaia, Tay Yu-Kwang Donovan, Van Uum Stan, Vokes Tamara, Winer Karen K, Yao Liang, Rejnmark Lars
Division of Endocrinology and Metabolism, McMaster University, Hamilton, Canada.
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
J Bone Miner Res. 2022 Dec;37(12):2663-2677. doi: 10.1002/jbmr.4716. Epub 2022 Oct 31.
Hypoparathyroidism (HypoPT) is a rare disorder characterized by hypocalcemia in the presence of a low or inappropriately normal parathyroid hormone level. HypoPT is most commonly seen after neck surgery, which accounts for approximately 75% of cases, whereas approximately 25% have HypoPT due to nonsurgical causes. In both groups of patients, conventional therapy includes calcium and active vitamin D analogue therapy aiming to maintain serum calcium concentration in the low normal or just below the normal reference range and normalize serum phosphorus, magnesium concentrations, and urine calcium levels. The limitations of conventional therapy include wide fluctuations in serum calcium, high pill burden, poor quality of life, and renal complications. Parathyroid hormone (PTH) replacement therapy may improve the biochemical profile in those in whom conventional therapy proves unsatisfactory. Based on a systematic review and meta-analysis of the literature, the panel made a graded recommendation suggesting conventional therapy as first line therapy rather than administration of PTH (weak recommendation, low quality evidence). When conventional therapy is deemed unsatisfactory, the panel considers use of PTH. Because pregnancy and lactation are associated with changes in calcium homeostasis, close monitoring is required during these periods with appropriate adjustment of calcium and active vitamin D analogue therapy to ensure that serum calcium remains in the mid to low normal reference range in order to avoid maternal and fetal complications. Emerging therapies include molecules with prolonged PTH action as well as different mechanisms of action that may significantly enhance drug efficacy and safety. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
甲状旁腺功能减退症（HypoPT）是一种罕见的疾病，其特征是在甲状旁腺激素水平低或不适当正常的情况下出现低钙血症。HypoPT最常见于颈部手术后，约占病例的75%，而约25%的患者因非手术原因患有HypoPT。在这两组患者中，传统治疗包括钙和活性维生素D类似物治疗，旨在将血清钙浓度维持在略低于正常参考范围的低正常水平，并使血清磷、镁浓度和尿钙水平正常化。传统治疗的局限性包括血清钙波动大、服药负担重、生活质量差和肾脏并发症。甲状旁腺激素（PTH）替代疗法可能会改善那些传统治疗效果不佳患者的生化指标。基于对文献的系统评价和荟萃分析，专家组提出了一项分级建议，建议将传统治疗作为一线治疗，而非给予PTH（弱推荐，低质量证据）。当认为传统治疗效果不佳时，专家组考虑使用PTH。由于妊娠和哺乳与钙稳态的变化有关，在这些时期需要密切监测，并适当调整钙和活性维生素D类似物治疗，以确保血清钙维持在正常参考范围的中低水平，以避免母婴并发症。新兴疗法包括具有延长PTH作用的分子以及可能显著提高药物疗效和安全性的不同作用机制。© 2022作者。《骨与矿物质研究杂志》由Wiley Periodicals LLC代表美国骨与矿物质研究学会（ASBMR）出版。
