Recombinant Parathyroid Hormone Infusion in the Management of Childhood Hypoparathyroidism.


Dr Swati Bhave    13 October 2017

Hypoparathyroidism associated with malabsorption can be particularly challenging to manage due to limited and erratic intestinal absorption of calcium and vitamin D analogues, resulting in episodes of hypo- or hyper-calcemia.A new article published in Hormone Research in Paediatrics evaluated the role of continuous subcutaneous recombinant parathyroid hormone (rhPTH 1-34) infusion (CSPI) in children with hypoparathyroidism associated with intestinal malabsorption resistant to conventional therapy.Here, four patients, in the age group of 8-13 years, with symptomatic hypo-calcemia resistant to conventional therapy, were started on CSPI. It was found that serum calcium of these children normalized within 48 hours of initiation the treatment. Additionally, an average rhPTH 1-34 dose of 0.4 g/kg/day resulted in a considerable reduction in symptomatic hypocalcemia and hypo-/hyper-calcemia-related hospital admissions. An increased alkaline phosphatase activity was noted in the first six months on CSPI, indicating an increase in bone turnover. Furthermore, elevated urinary calcium excretion before CSPI normalized in two patients, within the first year on treatment. Moreover, significant side effects were absent in the short or long term, with patient-reported preference of CSPI over conventional treatment.Thus, it was inferred that CSPI is a promising and effective treatment option for managing hypo-calcemia and hyper-phosphatemia in children with hypoparathyroidism associated with intestinal malabsorption.

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