Materiały źródłowe

• #1 Hypoparathyroidism – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hypoparathyroidism/diagnosis-treatment/drc-20355381

  The goal of treatment is to relieve symptoms and to bring calcium and phosphorus levels in your body back into a standard range. […] Treatment usually includes: […] Oral calcium supplements as tablets, chews or liquid can increase calcium levels in your blood. However, at high doses, calcium supplements can cause digestive side effects, such as constipation, in some people. […] High doses of vitamin D, generally in the form of calcitriol, can help your body absorb calcium and eliminate phosphorus. Calcitriol is a prescription from your health care provider for active vitamin D. This is different from the usual supplements you can get without a prescription. […] If your magnesium level is low and you’re experiencing symptoms of hypoparathyroidism, you may need to take a magnesium supplement.

• #2 Hypoparathyroidism: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22672-hypoparathyroidism

  Hypoparathyroidism is usually treated with calcium and vitamin D supplements. […] Treatment can include: Taking calcium carbonate and vitamin D supplements: Most people with hypoparathyroidism have to take calcium and vitamin D supplements for life. Its the go-to treatment option for hypoparathyroidism. Your body needs vitamin D to absorb and use calcium, so if you have hypoparathyroidism, you need to take both supplements. […] Getting parathyroid hormone (PTH) injections: If taking calcium and vitamin D supplements isnt working to treat your hypoparathyroidism, your provider might have you take parathyroid hormone injections. […] If a person with hypoparathyroidism has too much vitamin D and calcium as a part of their treatment, it can cause a high level of blood calcium (hypercalcemia), which can be harmful to your health. Because of this, youll have to have your blood monitored frequently to make sure your hypoparathyroidism treatment is working properly. […] Long-term use of parathyroid hormone injections may cause osteosarcoma, a type of bone cancer. For this reason, healthcare providers dont generally prescribe it to treat hypoparathyroidism unless its absolutely necessary.

• #3 How is hypoparathyroidism treated? | NICHD – Eunice Kennedy Shriver National Institute of Child Health and Human Development

  http://www.nichd.nih.gov/health/topics/hypopara/conditioninfo/treatment

  Unlike most other hormonal deficits, hypoparathyroidism is not treated with replacement of the missing hormone, parathyroid hormone (PTH). […] Currently, the standard treatment for hypoparathyroidism consists of activated vitamin D (calcitriol) and calcium supplements. Some people may also need magnesium supplementation. […] The development of PTH as a replacement therapy in patients with hypoparathyroidism was first explored by NICHD investigators beginning in 1992. […] In January 2015, the U.S. Food and Drug Administration approved PTH 1-84 for adult hypoparathyroidism patients who do not respond well to standard treatment, as an add-on to that treatment.

• #4 ESE Clinical Guideline: Treatment of chronic hypoparathyroidism in adults | ESE

  https://www.ese-hormones.org/publications/directory/ese-clinical-guideline-treatment-of-chronic-hypoparathyroidism-in-adults/

  Hypoparathyroidism (HypoPT) is a rare (orphan) endocrine disease with low calcium and inappropriately low (insufficient) circulating parathyroid hormone levels, most often in adults secondary to thyroid surgery. Standard treatment is activated vitamin D analogues and calcium supplementation and not replacement of the lacking hormone, as in other hormonal deficiency states. […] The purpose of this guideline is to provide clinicians with guidance on the treatment and monitoring of chronic HypoPT in adults who do not have end-stage renal disease.

• #5 Hypoparathyroidism Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/122207-treatment

  Treatment of patients with hypoparathyroidism involves correcting the hypocalcemia by administering calcium and vitamin D. […] Palopegteriparatide (Yorvipath) is a prodrug of the parathyroid hormone analog PTH(1-34) and is commercially available in the United States for treatment of hypoparathyroidism in adults. It is administered as a subcutaneous injection given once daily. Similar to endogenous PTH, PTH(1-34) released from palopegteriparatide raises serum calcium and reduces serum phosphate, thus maintaining extracellular calcium and phosphate homeostasis. […] Guidelines on chronic hypoparathyroidism by the European Society of Endocrinology, released in 2015, are below: Consider a diagnosis of chronic hypoparathyroidism (HypoPT) in a patient with hypocalcemia and inappropriately low parathyroid hormone (PTH) levels.

• #6 Hypoparathyroidism – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/parathyroid-disorders/hypoparathyroidism

  Hypoparathyroidism is a deficiency of parathyroid hormone often caused by an autoimmune disorder or by iatrogenic damage or removal of the parathyroid glands during thyroidectomy or parathyroidectomy. […] Treatment includes calcium and vitamin D supplementation. […] In transient hypoparathyroidism after thyroidectomy or partial parathyroidectomy, supplemental oral calcium may be sufficient: 1 to 2 g of elemental calcium/day may be given as calcium gluconate (90 mg elemental calcium/1 g) or calcium carbonate (400 mg elemental calcium/1 g). […] Prolonged parenteral administration of calcium may be necessary postoperatively; intravenous supplementation with as much as 1 g/day of elemental calcium (eg, 111 mL/day of calcium gluconate, which contains 90 mg elemental calcium/10 mL) may be required for 5 to 10 days before oral calcium and vitamin D are sufficient.

• #7 Hypoparathyroidism – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hypoparathyroidism/diagnosis-treatment/drc-20355381

  The goal of treatment is to relieve symptoms and to bring calcium and phosphorus levels in your body back into a standard range. […] Treatment usually includes: […] Oral calcium supplements as tablets, chews or liquid can increase calcium levels in your blood. However, at high doses, calcium supplements can cause digestive side effects, such as constipation, in some people. […] High doses of vitamin D, generally in the form of calcitriol, can help your body absorb calcium and eliminate phosphorus. Calcitriol is a prescription from your health care provider for active vitamin D. This is different from the usual supplements you can get without a prescription. […] If your magnesium level is low and you’re experiencing symptoms of hypoparathyroidism, you may need to take a magnesium supplement.

• #8 Hypoparathyroidism – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441899/

  Hypoparathyroidism treatment primarily consists of correcting calcium, vitamin D, and magnesium deficiencies with supplementation. […] Within the last several years, recombinant human parathyroid hormone became available and is currently used as replacement therapy in patients unresponsive to supplementation. […] In stable patients diagnosed with hypoparathyroidism after neck surgeries (eg, thyroidectomy), the recommended standard treatment is oral elemental calcium 2 to 3 g and calcitriol .5 to 1.5 g daily. […] Long-term PTH deficiency treatment also involves supplementation with calcium and vitamin D to keep serum calcium levels at 8 to 9 mg/dL. […] While most patients with hypoparathyroidism are still treated with calcitriol and calcium, selected patients who are more difficult to control with standard therapy can be treated with parathyroid hormone replacement.

• #9 Current treatment – Parathyroid UK

  https://parathyroiduk.org/hypoparathyroidism/current-treatment-of-hypopara/

  Permanent hypoparathyroidism requires lifelong treatment with oral medication. It is important that you take your tablets every day. […] The aim of hypopara treatment is to abolish symptoms, not to restore ‘normal’ calcium levels in the blood. This means that you need to keep your calcium levels high enough to avoid symptoms of hypocalcaemia but low enough to avoid causing problems with the kidneys. […] A long term maintenance level of 2.00mmol/L to 2.25 mmol/L is recommended in order to help protect your kidneys. This may be difficult for some people to achieve. […] You will need to take a vitamin D analogue and a calcium supplement. […] Alfacalcidol and Rocaltrol are the brand names of different types of vitamin D analogues which provide calcitriol (the active vitamin D, or hormone also known as 1,25-dihydroxycholecalciferol).

• #10 Hypoparathyroidism – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hypoparathyroidism/diagnosis-treatment/drc-20355381

  The goal of treatment is to relieve symptoms and to bring calcium and phosphorus levels in your body back into a standard range. […] Treatment usually includes: […] Oral calcium supplements as tablets, chews or liquid can increase calcium levels in your blood. However, at high doses, calcium supplements can cause digestive side effects, such as constipation, in some people. […] High doses of vitamin D, generally in the form of calcitriol, can help your body absorb calcium and eliminate phosphorus. Calcitriol is a prescription from your health care provider for active vitamin D. This is different from the usual supplements you can get without a prescription. […] If your magnesium level is low and you’re experiencing symptoms of hypoparathyroidism, you may need to take a magnesium supplement.

• #11 Treatments for HypoPT

  https://www.webmd.com/women/hypoparathyroidism-treatment-plan

  Vitamin D. This vitamin can help your body absorb calcium and get rid of phosphorus. For hyperparathyroidism, doctors may give you calcitriol (Rocaltrol). This is a prescription medication. It contains active vitamin D, which is different from a regular vitamin D supplement that youd buy at the store. […] Thiazide diuretics. Sometimes your calcium levels will still be low even if you take calcium supplements or use other treatments for hypoparathyroidism. […] Magnesium supplements. If you have low magnesium levels with hypoparathyroidism, talk to your doctor about a magnesium supplement. This kind of treatment can help give your body the correct amount of magnesium. […] Palopegteriparatide (Yorvipath) injections. Palopegteriparatide, which is a synthetic form of the human parathyroid hormone, was approved by the FDA to treat hypoparathyroidism in adults.

• #12 Current treatment – Parathyroid UK

  https://parathyroiduk.org/hypoparathyroidism/current-treatment-of-hypopara/

  Permanent hypoparathyroidism requires lifelong treatment with oral medication. It is important that you take your tablets every day. […] The aim of hypopara treatment is to abolish symptoms, not to restore ‘normal’ calcium levels in the blood. This means that you need to keep your calcium levels high enough to avoid symptoms of hypocalcaemia but low enough to avoid causing problems with the kidneys. […] A long term maintenance level of 2.00mmol/L to 2.25 mmol/L is recommended in order to help protect your kidneys. This may be difficult for some people to achieve. […] You will need to take a vitamin D analogue and a calcium supplement. […] Alfacalcidol and Rocaltrol are the brand names of different types of vitamin D analogues which provide calcitriol (the active vitamin D, or hormone also known as 1,25-dihydroxycholecalciferol).

• #13 Hypoparathyroidism – Parathyroid Gland Diseases – Endocrinology – Diseases – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.II.10.1.

  Management requires close monitoring of the biochemical profile and drug therapy to minimize symptoms of hypocalcemia while avoiding overtreatment with the development of hypercalcemia. Prevention of long-term complications requires avoidance of hypercalciuria and hyperphosphatemia. Conventional therapy includes calcium and active vitamin D supplementation. PTH replacement therapy is of value in those in whom conventional therapy has failed. […] Treatment goals of chronic management are to reduce symptoms of hypocalcemia and the risk of long-term complications of hypercalciuria and hyperphosphatemia. Conventional therapy includes calcium supplementation and active vitamin D and its analogues. […] Failure of conventional therapy is confirmed in the presence of poor control of serum calcium, complications of hypoparathyroidism or its treatment, or poor quality of life; in such cases patients can be offered PTH therapy. […] PTH therapy can be considered in the presence of symptomatic hypocalcemia despite conventional therapy.

• #14 Hypoparathyroidism – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hypoparathyroidism/diagnosis-treatment/drc-20355381

  If your calcium levels remain low even with treatment, or if the amount of calcium in your urine is very high, thiazide diuretics can help decrease the amount of calcium lost through your urine. […] The U.S. Food and Drug Administration (FDA) has approved parathyroid hormone (Natpara) for low blood calcium due to hypoparathyroidism. This is a once-daily injection. Because of the potential risk of bone cancer (osteosarcoma), a risk observed in animal studies, this drug is available only through a restricted program. The program limits use to people whose calcium levels can’t be controlled with calcium and vitamin D supplements and who understand the risks. […] Your health care provider might recommend that you consult a registered dietitian, who is likely to advise a diet that’s: […] If you need immediate symptom relief, you may need to stay in the hospital so that you can receive calcium by a small tube in a vein in your hand or arm (intravenously). You’ll also take oral vitamin D tablets. After you leave the hospital, you’ll continue to take calcium and vitamin D tablets.

• #15 Treatments for HypoPT

  https://www.webmd.com/women/hypoparathyroidism-treatment-plan

  Vitamin D. This vitamin can help your body absorb calcium and get rid of phosphorus. For hyperparathyroidism, doctors may give you calcitriol (Rocaltrol). This is a prescription medication. It contains active vitamin D, which is different from a regular vitamin D supplement that youd buy at the store. […] Thiazide diuretics. Sometimes your calcium levels will still be low even if you take calcium supplements or use other treatments for hypoparathyroidism. […] Magnesium supplements. If you have low magnesium levels with hypoparathyroidism, talk to your doctor about a magnesium supplement. This kind of treatment can help give your body the correct amount of magnesium. […] Palopegteriparatide (Yorvipath) injections. Palopegteriparatide, which is a synthetic form of the human parathyroid hormone, was approved by the FDA to treat hypoparathyroidism in adults.

• #16 Treatment options in hypoparathyroidism – Archives of Endocrinology and Metabolism

  https://www.aem-sbem.com/article/treatment-options-in-hypoparathyroidism/

  Hypoparathyroidism remains the single endocrine deficiency disease that is not habitually treated with the missing hormone. […] In this article, we aim to provide a review of the conventional approach and the novel therapies as well as an overview of the perspectives on the treatment of this rare condition. […] Conventional treatment involves calcium salts and vitamin D analogs. […] Thiazide diuretics can be used to reduce hypercalciuria in some cases. […] The use of PTH analogs is a new approach despite the limitation of high cost. […] Studies have included modified PTH molecules, calcilytics, microencapsulation of human parathyroid cells, and allotransplantation.

• #17 Hypoparathyroidism – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441899/

  Treatment with daily subcutaneous injections of a parathyroid hormone analog, alopegteriparatide, has been shown to normalize serum calcium and phosphorus, lower urine calcium excretion, and improve quality of life. […] The recently published guidelines of the Second International Workshop recommend that clinicians consider parathyroid hormone replacement for those not adequately controlled by conventional therapy (ie, with symptomatic hypocalcemia, hyperphosphatemia, renal insufficiency, hypercalciuria, or poor quality of life).

• #18 Challenges in the management of chronic hypoparathyroidism in: Endocrine Connections Volume 9 Issue 10 (2020)

  https://ec.bioscientifica.com/view/journals/ec/9/10/EC-20-0366.xml

  The first adjunctive hormone therapy for chronic hypoparathyroidism, recombinant human parathyroid hormone (184) (rhPTH(184)) was approved by the FDA in January 2015. […] Conventional therapy with calcium and activated forms of vitamin D are currently the mainstays of treatment for most patients with chronic hypoparathyroidism. […] Hormone therapy can be administered through FDA-approved once-daily rhPTH(184), or off-label multiple-daily injections of teriparatide. The former is the only FDA-approved drug, with safety and efficacy supported by a randomized placebo-controlled trial and open-label long-term extension trial data. […] New pharmacological options that replace the deficient hormone will likely be available within the next few years. […] Conventional therapy with calcium and active vitamin D supplementation remains the mainstay of treatment for chronic hypoparathyroidism, as recommended by at least three sets of clinical guidelines.

• #19 Managing Hypoparathyroidism | NATPARA® (parathyroid hormone)

  https://www.natpara.com/managing-hypoparathyroidism

  NATPARA is the first and only FDA-approved prescription parathyroid hormone that is taken along with calcium and vitamin D to control hypocalcemia in adults with hypoparathyroidism. […] NATPARA helps to control your blood calcium level. NATPARA helps raise low blood calcium levels caused by hypoparathyroidism. […] NATPARA may cause serious side effects, including: High blood calcium (hypercalcemia). […] NATPARA helped reduce the need for oral calcium supplements and reduced or removed the need for active vitamin D. […] 55% of patients who received NATPARA reduced their active vitamin D and oral calcium use by at least half while maintaining calcium levels in the blood within a target range compared with 3% in the placebo group. […] 42% of patients who received NATPARA were able to stop all use of active vitamin D and to reduce their oral calcium to no more than 500 mg per day compared with 3% in the placebo group. […] 69% of patients who received NATPARA reduced their oral calcium use by at least half compared with 8% in the placebo group. […] People who stop using or miss a dose of NATPARA may have an increased risk of severe low blood calcium levels.

• #20 The PARADIGHM (physicians advancing disease knowledge in hypoparathyroidism) registry for patients with chronic hypoparathyroidism: study protocol and interim baseline patient characteristics | BMC Endocrine Disorders | Full Text

  https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-021-00888-2

  In the United States, rhPTH(1-84) is indicated as an adjunct to calcium and vitamin D to control hypocalcemia and is recommended only for patients who cannot be well controlled with calcium supplements and active vitamin D alone. […] The safety and efficacy of rhPTH(1-84) in patients with chronic hypoparathyroidism were first shown in short-term placebo-controlled clinical studies in which the need for conventional therapy was reduced, serum calcium levels were maintained, serum phosphate decreased, and events of hypocalcemia were reduced. […] In longer-term, open-label clinical studies, no new safety concerns were observed, reductions in oral calcium supplements and active vitamin D were achieved, serum calcium remained within target range, serum phosphorus and calcium-phosphate product levels improved, and urinary calcium excretion normalized.

• #21

  https://link.springer.com/article/10.1007/s12020-020-02577-x

  Chronic hypoparathyroidism is usually treated with calcium and active vitamin D metabolites or analogs, despite the fact that their chronic use can lead to long-term complications. The use of hormone replacement therapy with PTH peptides [teriparatide and rhPTH (184)] has therefore been proposed. The main purpose of this study was to investigate the efficacy of teriparatide dose at 20g once or twice daily, in order to maintain normocalcemia reducing standard treatment, in adult patients with chronic hypoparathyroidism not well controlled with conventional treatment. […] This study showed that teriparatide 20g once daily was insufficient to discontinue calcium and calcitriol supplements to maintain normal serum calcium concentrations. Conversely, for more than half of patients treated with teriparatide 20g twice daily, calcium and calcitriol administration was avoidable, but in some cases at the expense of serum calcium and phosphate oscillations.

• #22 Treatment of unresponsive hypoparathyroidism when the oral route administration is not possible: Considering subcutaneous teriparatide | Endocrinología y Nutrición (English Edition)

  https://www.elsevier.es/en-revista-endocrinologia-nutricion-english-edition–412-articulo-treatment-unresponsive-hypoparathyroidism-when-oral-S2173509315000926

  Treatment of unresponsive hypoparathyroidism when the oral route administration is not possible: Considering subcutaneous teriparatide […] The usual chronic management of hypoparathyroidism is supplementation with calcium and 1,25-OH vitamin D (calcitriol) in variable doses. However, this treatment is sometimes insufficient. […] Conventional treatment of hypoparathyroidism with calcium, magnesium, and calcitriol supplementation was started. […] At this point we decided to start treatment with subcutaneous parathyroid hormone. […] Exceptionally, as in the present case, off-label use of teriparatide is allowed. Recent prospective studies have demonstrated the efficacy and safety of treatment with subcutaneous PTH in hypoparathyroidism of different causes, for up to 4 years. […] It has been demonstrated that treatment with PTH 184 leads to a significant decrease in calcium supplements of about 37%, and of vitamin D around 45%. […] In conclusion, unresponsive hypoparathyroidism is a rare entity that can be controlled effectively by means of subcutaneous PTH, administered either by continuous infusion pump or by multiple injections.

• #23 Hypoparathyroidism Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/122207-treatment

  Treatment of patients with hypoparathyroidism involves correcting the hypocalcemia by administering calcium and vitamin D. […] Palopegteriparatide (Yorvipath) is a prodrug of the parathyroid hormone analog PTH(1-34) and is commercially available in the United States for treatment of hypoparathyroidism in adults. It is administered as a subcutaneous injection given once daily. Similar to endogenous PTH, PTH(1-34) released from palopegteriparatide raises serum calcium and reduces serum phosphate, thus maintaining extracellular calcium and phosphate homeostasis. […] Guidelines on chronic hypoparathyroidism by the European Society of Endocrinology, released in 2015, are below: Consider a diagnosis of chronic hypoparathyroidism (HypoPT) in a patient with hypocalcemia and inappropriately low parathyroid hormone (PTH) levels.

• #24 FDA approves new drug for hypoparathyroidism, a rare disorder | FDA

  https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-new-drug-hypoparathyroidism-rare-disorder

  The U.S. Food and Drug Administration has approved Yorvipath (palopegteriparatide) injection for subcutaneous use in adults with hypoparathyroidism. […] Patients with hypoparathyroidism are typically treated with active vitamin D and calcium to raise blood calcium into the low-normal range and can require large doses of calcium taken more than once a day. […] At the end of the trial, 69% of the patients in the Yorvipath group compared to 5% of the patients in the placebo group were able to maintain their calcium level in the normal range, without needing active vitamin D and high doses of calcium (calcium dose 600 mg/day).

• #25 Treatment of Hypoparathyroidism by Re-Establishing the Effects of Parathyroid Hormone

  https://www.e-enm.org/journal/view.php?number=2480

  A phase 3 study demonstrated maintenance of normocalcemia in patients with chronic HypoPT, with no need for conventional therapy. Furthermore, this treatment lowers urinary calcium and improves QoL. […] Another long-acting PTH analog with effects on the parathyroid hormone receptor (eneboparatide) is currently being tested in a phase 3 trial. […] All in all, improved treatment options are on the way that will likely take the treatment of HypoPT to the next level. […] Despite normalizing plasma calcium levels, thereby alleviating severe symptoms of hypocalcemia, conventional treatment of HypoPT with active vitamin D and calcium supplements is associated with unpredictable fluctuations in plasma calcium levels, hypercalciuria, and several complications, including an increased risk of impaired kidney function and impaired QoL. Substitution with the missing hormone using rhPTH(1-84) or PTH(1-34) has been shown to reduce the need for conventional therapy; however, due to the short duration of action, replacement therapy with these analogues is not ideal. Palopegteriparatide is a prodrug with sustained release of PTH(1-34) designed to provide stable PTH levels in the physiological range for 24 hours/day and has recently been approved for treatment of chronic HypoPT in Europe. Treatment with eneboparatide and encaleret also seems to cause long-acting effects on the calcium-PTH axis, and phase 3 clinical trials are currently ongoing aiming to demonstrate a normalization of calcium homeostasis in response to treatment of patients with chronic HypoPT.

• #26 FDA approves new drug for hypoparathyroidism, a rare disorder | FDA

  https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-new-drug-hypoparathyroidism-rare-disorder

  The U.S. Food and Drug Administration has approved Yorvipath (palopegteriparatide) injection for subcutaneous use in adults with hypoparathyroidism. […] Patients with hypoparathyroidism are typically treated with active vitamin D and calcium to raise blood calcium into the low-normal range and can require large doses of calcium taken more than once a day. […] At the end of the trial, 69% of the patients in the Yorvipath group compared to 5% of the patients in the placebo group were able to maintain their calcium level in the normal range, without needing active vitamin D and high doses of calcium (calcium dose 600 mg/day).

• #27 Addressing Unmet Needs: Novel Therapies in the Treatment of Adult Hypoparathyroidism – Endocrinology Advisor

  https://www.endocrinologyadvisor.com/cch/hypoparathyroidism-parathyroid-hormone-palopegteriparatide-calcium-vitamin-d/

  PTH therapy has been shown to improve QOL, reduce pill burden, and lower serum phosphate levels while maintaining serum calcium in the normal reference range. It is indeed a major advance in the treatment of hypoPT. […] This molecule can provide circulating PTH levels in the normal reference range throughout the 24-hour time period and can normalize serum calcium while lowering serum phosphate and the 24-hour urine calcium. […] It allows patients to stop active vitamin D and reduce the calcium supplement to 600 mg or less daily in 93% of patients. […] Patients with hypoPT do have significantly impaired QOL due to multiple factors. The wide fluctuations in serum calcium are disabling in many patients and the neurologic manifestations with numbness and tingling in the face, hands, and feet can prevent an individual from engaging in a meaningful work schedule.

• #28 Hypoparathyroidism – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hypoparathyroidism/diagnosis-treatment/drc-20355381

  If your calcium levels remain low even with treatment, or if the amount of calcium in your urine is very high, thiazide diuretics can help decrease the amount of calcium lost through your urine. […] The U.S. Food and Drug Administration (FDA) has approved parathyroid hormone (Natpara) for low blood calcium due to hypoparathyroidism. This is a once-daily injection. Because of the potential risk of bone cancer (osteosarcoma), a risk observed in animal studies, this drug is available only through a restricted program. The program limits use to people whose calcium levels can’t be controlled with calcium and vitamin D supplements and who understand the risks. […] Your health care provider might recommend that you consult a registered dietitian, who is likely to advise a diet that’s: […] If you need immediate symptom relief, you may need to stay in the hospital so that you can receive calcium by a small tube in a vein in your hand or arm (intravenously). You’ll also take oral vitamin D tablets. After you leave the hospital, you’ll continue to take calcium and vitamin D tablets.

• #29 Treatment of hypocalcemia – UpToDate

  https://www.uptodate.com/contents/treatment-of-hypocalcemia

  INTRODUCTION […] Hypocalcemia may be associated with a spectrum of clinical manifestations, ranging from few (if any) symptoms if the hypocalcemia is mild and/or chronic to severe life-threatening symptoms if it is severe and/or acute. Thus, the management of hypocalcemia depends upon the severity of symptoms. In patients with acute symptomatic hypocalcemia, intravenous (IV) calcium gluconate is the preferred therapy, whereas chronic hypocalcemia is treated with oral calcium and vitamin D supplements. […] […] Oral treatment of chronic hypocalcemia in hypoparathyroidism.

• #30

  https://www.healio.com/clinical-guidance/hypoparathyroidism/treatment-objectives-treatment-options

  The primary objective of hypoparathyroidism (hypoPT) treatment is to correct symptomatic hypocalcemia and try to achieve a serum calcium which is just below the normal reference range or in the low normal reference range. It is also to normalize phosphate and correct hypercalciuria in order to minimize the risk of renal complications. Other treatment objectives include improving quality of life (QoL) and reducing the risk of multisystem complications arising from hypoPT. […] Patients with hypoPT who present with severe acute signs and symptoms of hypocalcemia, including tetany, carpopedal spasm, seizures, bronchospasm, laryngospasm, or cardiac arrhythmias, require emergency room assessment and administration of intravenous (IV) calcium salts. […] Continuous infusion of calcium salts may be necessary to prevent recurrent hypocalcemia. A typical approach involves infusing 10 ampules of 10% calcium gluconate in 1L of 5% dextrose in water or 0.9% saline at a starting rate of 50 mL per hour, with frequent monitoring of serum calcium levels. Administered over 4-6 hours, 10 mL/kg of this solution is expected to raise serum calcium levels by 0.3 to 0.5 mmol/L (or 1.2 to 2.0 mg/dL). […] Adverse events (AE) which may occur with administration of IV calcium include development of a chalky taste, hot flushes, and peripheral vasodilation.

• #31 Hypoparathyroidism: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000385.htm

  The goal of treatment is to reduce symptoms and restore the calcium and mineral balance in the body. Treatment involves calcium carbonate and vitamin D supplements. These usually must be taken for life. Blood levels are measured regularly to make sure that the dose is correct. A high-calcium, low-phosphorous diet is recommended. […] Injections of PTH may be recommended for some people. Your provider can tell you if this medicine is right for you. […] People who have life-threatening attacks of low calcium levels or prolonged muscle contractions are given calcium through a vein (IV). Precautions are taken to prevent seizures or larynx spasms. Your heart is monitored for abnormal rhythms until you are stable. When the life-threatening attack has been controlled, treatment continues with medicine taken by mouth.

• #32 Hypoparathyroidism – UF Health

  https://ufhealth.org/conditions-and-treatments/hypoparathyroidism

  The goal of treatment is to reduce symptoms and restore the calcium and mineral balance in the body. Treatment involves calcium carbonate and vitamin D supplements. These usually must be taken for life. Blood levels are measured regularly to make sure that the dose is correct. A high-calcium, low-phosphorous diet is recommended. […] Injections of PTH may be recommended for some people. Your doctor can tell you if this medicine is right for you. […] People who have life-threatening attacks of low calcium levels or prolonged muscle contractions are given calcium through a vein (IV). Precautions are taken to prevent seizures or larynx spasms. The heart is monitored for abnormal rhythms until the person is stable. When the life-threatening attack has been controlled, treatment continues with medicine taken by mouth.

• #33 Hypoparathyroidism Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/122207-treatment

  Use activated vitamin D analogues plus calcium supplements in divided doses as the primary therapy. […] If the autotransplantation fails, patients receive the same treatment that is administered to other patients with hypoparathyroidism. […] A diet rich in calcium content (ie, emphasizing dairy products) is recommended for patients with primary hypoparathyroidism.

• #34 Hypoparathyroidism: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/122207-overview

  Treatment of patients with hypoparathyroidism involves correcting the hypocalcemia by administering calcium and vitamin D. […] Palopegteriparatide (Yorvipath) is a prodrug of the parathyroid hormone analog PTH(1-34) and is commercially available in the United States for treatment of hypoparathyroidism in adults. […] A diet rich in calcium content (ie, emphasizing dairy products) is recommended for patients with primary hypoparathyroidism. […] Patients undergoing parathyroidectomy for parathyroid hyperplasia are at high risk of developing permanent primary hypoparathyroidism. Patients may be treated with an autotransplant of a segment of parathyroid gland to prevent hypoparathyroidism. […] If the autotransplantation fails, patients receive the same treatment that is administered to other patients with hypoparathyroidism.

• #35 Hypoparathyroidism – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hypoparathyroidism/diagnosis-treatment/drc-20355381

  Your health care provider will regularly check your blood to monitor levels of calcium and phosphorus. At first, these tests will probably be weekly to monthly. Eventually, you’ll need blood tests just twice a year. Regular testing allows adjustment of your supplemental calcium dose if your blood-calcium levels rise or fall. […] Because hypoparathyroidism is usually a long-lasting disorder, testing and treatment generally is lifelong.

• #36 Hypoparathyroidism

  https://www.nhs.uk/conditions/hypoparathyroidism/

  Hypoparathyroidism can be treated by taking: […] calcium supplements to raise the level of calcium in your body […] vitamin D supplements vitamin D helps your body make better use of calcium. […] You’ll usually need to take supplements for the rest of your life. […] You may be offered supplements even if you do not have any symptoms, but tests show damage to your parathyroid glands. This helps lower the risk of any serious problems. […] You’ll need regular blood tests to check your calcium levels. […] If these tests show supplements are not working well, then you may need extra medicines.

• #37 Continuous rhPTH (1–34) treatment in chronic hypoparathyroidism in: Endocrinology, Diabetes & Metabolism Case Reports Volume 2020 Issue 1 (2020)

  https://edm.bioscientifica.com/view/journals/edm/2020/1/EDM20-0009.xml

  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. […] 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. […] In those cases, continuous s.c. administration of parathyroid hormone via insulin pump may represent a successful treatment alternative. […] However, we were able to normalize serum calcium and phosphate levels by continuous s.c. rhPTH (134) administration, reducing severe clinical manifestations in all three patients without causing hypercalcemic episodes and hypercalciuria. […] In conclusion, in cases where even PTH injections do not allow sufficient disease control, long-term PTH pump therapy represents an alternative option, providing long-term stabilization of calcium and phosphate homeostasis.

• #38 Treatment of Hypoparathyroidism by Re-Establishing the Effects of Parathyroid Hormone

  https://www.e-enm.org/journal/view.php?number=2480

  A phase 3 study demonstrated maintenance of normocalcemia in patients with chronic HypoPT, with no need for conventional therapy. Furthermore, this treatment lowers urinary calcium and improves QoL. […] Another long-acting PTH analog with effects on the parathyroid hormone receptor (eneboparatide) is currently being tested in a phase 3 trial. […] All in all, improved treatment options are on the way that will likely take the treatment of HypoPT to the next level. […] Despite normalizing plasma calcium levels, thereby alleviating severe symptoms of hypocalcemia, conventional treatment of HypoPT with active vitamin D and calcium supplements is associated with unpredictable fluctuations in plasma calcium levels, hypercalciuria, and several complications, including an increased risk of impaired kidney function and impaired QoL. Substitution with the missing hormone using rhPTH(1-84) or PTH(1-34) has been shown to reduce the need for conventional therapy; however, due to the short duration of action, replacement therapy with these analogues is not ideal. Palopegteriparatide is a prodrug with sustained release of PTH(1-34) designed to provide stable PTH levels in the physiological range for 24 hours/day and has recently been approved for treatment of chronic HypoPT in Europe. Treatment with eneboparatide and encaleret also seems to cause long-acting effects on the calcium-PTH axis, and phase 3 clinical trials are currently ongoing aiming to demonstrate a normalization of calcium homeostasis in response to treatment of patients with chronic HypoPT.

• #39 Treatment of Hypoparathyroidism by Re-Establishing the Effects of Parathyroid Hormone

  https://www.e-enm.org/journal/view.php?number=2480

  A phase 3 study demonstrated maintenance of normocalcemia in patients with chronic HypoPT, with no need for conventional therapy. Furthermore, this treatment lowers urinary calcium and improves QoL. […] Another long-acting PTH analog with effects on the parathyroid hormone receptor (eneboparatide) is currently being tested in a phase 3 trial. […] All in all, improved treatment options are on the way that will likely take the treatment of HypoPT to the next level. […] Despite normalizing plasma calcium levels, thereby alleviating severe symptoms of hypocalcemia, conventional treatment of HypoPT with active vitamin D and calcium supplements is associated with unpredictable fluctuations in plasma calcium levels, hypercalciuria, and several complications, including an increased risk of impaired kidney function and impaired QoL. Substitution with the missing hormone using rhPTH(1-84) or PTH(1-34) has been shown to reduce the need for conventional therapy; however, due to the short duration of action, replacement therapy with these analogues is not ideal. Palopegteriparatide is a prodrug with sustained release of PTH(1-34) designed to provide stable PTH levels in the physiological range for 24 hours/day and has recently been approved for treatment of chronic HypoPT in Europe. Treatment with eneboparatide and encaleret also seems to cause long-acting effects on the calcium-PTH axis, and phase 3 clinical trials are currently ongoing aiming to demonstrate a normalization of calcium homeostasis in response to treatment of patients with chronic HypoPT.

• #40 New Hypoparathyroidism Guidelines and Emerging PTH Replacement Therapies for Improved Patient Outcomes – UCSF MedConnection

  https://medconnection.ucsfhealth.org/news/new-hypoparathyroidism-guidelines-and-emerging-pth-replacement-therapies-for-improved-patient-outcomes

  New guidelines from the Second International Workshop on the Evaluation and Management of Hypoparathyroidism provide clinicians with the latest evidence-based recommendations for the prevention, diagnosis and management of this rare disease. […] The new guidelines cover: […] Managing patients with hypoparathyroidism first-line treatments and PTH therapy. […] For patients whose disease isnt well controlled by these first-line treatments, PTH therapy is a promising option but not yet the standard of care. […] The guidelines provide a framework for patients who arent well controlled on conventional management and who might be candidates for injectable PTH therapy, Shoback said. […] UCSF researchers, including transplant surgeon Peter G. Stock, MD, and endocrine surgeon Julie Ann Sosa, MD, MA, FACS, chair of the UCSF Department of Surgery and president of the American Thyroid Association, are investigating parathyroid allotransplantation as a potential treatment for severe hypoparathyroidism. […] We provide our patients with a high level of specialty care, Shoback said.

• #41 Treatment of Hypoparathyroidism by Re-Establishing the Effects of Parathyroid Hormone

  https://www.e-enm.org/journal/view.php?number=2480

  The conventional treatment of hypoparathyroidism includes active vitamin D and calcium. Despite normalization of calcium levels, the conventional treatment is associated with fluctuations in calcium levels, hypercalciuria, renal impairment, and decreased quality of life. […] Instead of conventional treatment, replacement therapy with a parathyroid hormone analogue with a long duration of action appears to be an emerging treatment for hypoparathyroidism. […] Replacement therapy with parathyroid hormone (PTH)(1-84) is an option in some countries. However, convincing beneficial effects have not been demonstrated, which may be due to the short duration of action of this treatment. […] Recently, palopegteriparatide (also known as TransCon PTH) has been marketed in Europe and is expected also to be approved in other countries. Palopegteriparatide is a prodrug with sustained release of PTH(1-34) designed to provide stable physiological PTH levels for 24 hours/day.

• #42 Treatment of Hypoparathyroidism by Re-Establishing the Effects of Parathyroid Hormone

  https://www.e-enm.org/journal/view.php?number=2480

  A phase 3 study demonstrated maintenance of normocalcemia in patients with chronic HypoPT, with no need for conventional therapy. Furthermore, this treatment lowers urinary calcium and improves QoL. […] Another long-acting PTH analog with effects on the parathyroid hormone receptor (eneboparatide) is currently being tested in a phase 3 trial. […] All in all, improved treatment options are on the way that will likely take the treatment of HypoPT to the next level. […] Despite normalizing plasma calcium levels, thereby alleviating severe symptoms of hypocalcemia, conventional treatment of HypoPT with active vitamin D and calcium supplements is associated with unpredictable fluctuations in plasma calcium levels, hypercalciuria, and several complications, including an increased risk of impaired kidney function and impaired QoL. Substitution with the missing hormone using rhPTH(1-84) or PTH(1-34) has been shown to reduce the need for conventional therapy; however, due to the short duration of action, replacement therapy with these analogues is not ideal. Palopegteriparatide is a prodrug with sustained release of PTH(1-34) designed to provide stable PTH levels in the physiological range for 24 hours/day and has recently been approved for treatment of chronic HypoPT in Europe. Treatment with eneboparatide and encaleret also seems to cause long-acting effects on the calcium-PTH axis, and phase 3 clinical trials are currently ongoing aiming to demonstrate a normalization of calcium homeostasis in response to treatment of patients with chronic HypoPT.

• #43 Addressing Unmet Needs: Novel Therapies in the Treatment of Adult Hypoparathyroidism – Endocrinology Advisor

  https://www.endocrinologyadvisor.com/cch/hypoparathyroidism-parathyroid-hormone-palopegteriparatide-calcium-vitamin-d/

  PTH therapy has been shown to improve QOL, reduce pill burden, and lower serum phosphate levels while maintaining serum calcium in the normal reference range. It is indeed a major advance in the treatment of hypoPT. […] This molecule can provide circulating PTH levels in the normal reference range throughout the 24-hour time period and can normalize serum calcium while lowering serum phosphate and the 24-hour urine calcium. […] It allows patients to stop active vitamin D and reduce the calcium supplement to 600 mg or less daily in 93% of patients. […] Patients with hypoPT do have significantly impaired QOL due to multiple factors. The wide fluctuations in serum calcium are disabling in many patients and the neurologic manifestations with numbness and tingling in the face, hands, and feet can prevent an individual from engaging in a meaningful work schedule.

• #44 Addressing Unmet Needs: Novel Therapies in the Treatment of Adult Hypoparathyroidism – Endocrinology Advisor

  https://www.endocrinologyadvisor.com/cch/hypoparathyroidism-parathyroid-hormone-palopegteriparatide-calcium-vitamin-d/

  Conventional therapy can certainly improve serum calcium but may not be able to eliminate the fluctuations in serum calcium and may not be able to improve QOL. Also, the effects of inadequate PTH levels on neurocognition require further study; however, we have noticed dramatic improvements in well-being, function, and QOL with the implementation of PTH therapy.

• #45 Getting Back to Normal: Options for Treating Hypoparathyroidism – Endocrine News

  https://endocrinenews.endocrine.org/getting-back-to-normal-options-for-treating-hypoparathyroidism/

  Hypoparathyroidism can be a debilitating disorder, and treatment can increase the risk of long term complications and is difficult to follow due to the very large number of calcium and active vitamin D pills needed every day. […] Clinicians are investigating a prodrug that replaces parathyroid hormone in patients with hypoparathyroidism, and the results so far have been promising. […] Clinicians should be up to date on the latest guidelines, published in late 2022. Conventional treatment remains the first-line therapy, but PTH should be considered if conventional therapy fails. […] Khan says that 95% of participants in this current clinical trial were able to come off of active vitamin D, while stabilizing calcium and bone density with palopegteriparatide. This is really, really reassuring data, and its nice to be able to replace PTH, be able to normalize calcium levels, be able to correct the urine calcium, correct the phosphate levels, improve quality of life, she says.

• #46 Challenges in the management of chronic hypoparathyroidism in: Endocrine Connections Volume 9 Issue 10 (2020)

  https://ec.bioscientifica.com/view/journals/ec/9/10/EC-20-0366.xml

  Hormone therapy with rhPTH(184) stimulates bone turnover, returning bone turnover and bone density closer to normal, and further increases normal or relatively increased bone density at the lumbar spine, stabilizes hip bone density, and reduces it at the wrist. […] The FDA approved once-daily rhPTH(184) (Natpara, Shire/Takeda) for adjunctive therapy of chronic hypoparathyroidism in adults in January 2015. […] The REPLACE study was the pivotal 6-month phase 3 clinical trial that led to FDA approval of rhPTH(184) 50, 75, and 100 µg doses. […] The phase 3 24-week randomized, double-blind, placebo-controlled REPLACE trial demonstrated that 53% of patients who received rhPTH(184) were able to reduce both oral calcium and vitamin D supplements by more than 50% from baseline. […] Overall, it seems that patients with lower SF-36 scores at baseline before treatment and taking a greater number of daily supplement tablets appeared to benefit the most from adjunctive therapy.

• #47 Managing Hypoparathyroidism | NATPARA® (parathyroid hormone)

  https://www.natpara.com/managing-hypoparathyroidism

  NATPARA is the first and only FDA-approved prescription parathyroid hormone that is taken along with calcium and vitamin D to control hypocalcemia in adults with hypoparathyroidism. […] NATPARA helps to control your blood calcium level. NATPARA helps raise low blood calcium levels caused by hypoparathyroidism. […] NATPARA may cause serious side effects, including: High blood calcium (hypercalcemia). […] NATPARA helped reduce the need for oral calcium supplements and reduced or removed the need for active vitamin D. […] 55% of patients who received NATPARA reduced their active vitamin D and oral calcium use by at least half while maintaining calcium levels in the blood within a target range compared with 3% in the placebo group. […] 42% of patients who received NATPARA were able to stop all use of active vitamin D and to reduce their oral calcium to no more than 500 mg per day compared with 3% in the placebo group. […] 69% of patients who received NATPARA reduced their oral calcium use by at least half compared with 8% in the placebo group. […] People who stop using or miss a dose of NATPARA may have an increased risk of severe low blood calcium levels.

• #48 Hypoparathyroidism – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hypoparathyroidism/diagnosis-treatment/drc-20355381

  If your calcium levels remain low even with treatment, or if the amount of calcium in your urine is very high, thiazide diuretics can help decrease the amount of calcium lost through your urine. […] The U.S. Food and Drug Administration (FDA) has approved parathyroid hormone (Natpara) for low blood calcium due to hypoparathyroidism. This is a once-daily injection. Because of the potential risk of bone cancer (osteosarcoma), a risk observed in animal studies, this drug is available only through a restricted program. The program limits use to people whose calcium levels can’t be controlled with calcium and vitamin D supplements and who understand the risks. […] Your health care provider might recommend that you consult a registered dietitian, who is likely to advise a diet that’s: […] If you need immediate symptom relief, you may need to stay in the hospital so that you can receive calcium by a small tube in a vein in your hand or arm (intravenously). You’ll also take oral vitamin D tablets. After you leave the hospital, you’ll continue to take calcium and vitamin D tablets.

• #49 Hypoparathyroidism: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22672-hypoparathyroidism

  Hypoparathyroidism is usually treated with calcium and vitamin D supplements. […] Treatment can include: Taking calcium carbonate and vitamin D supplements: Most people with hypoparathyroidism have to take calcium and vitamin D supplements for life. Its the go-to treatment option for hypoparathyroidism. Your body needs vitamin D to absorb and use calcium, so if you have hypoparathyroidism, you need to take both supplements. […] Getting parathyroid hormone (PTH) injections: If taking calcium and vitamin D supplements isnt working to treat your hypoparathyroidism, your provider might have you take parathyroid hormone injections. […] If a person with hypoparathyroidism has too much vitamin D and calcium as a part of their treatment, it can cause a high level of blood calcium (hypercalcemia), which can be harmful to your health. Because of this, youll have to have your blood monitored frequently to make sure your hypoparathyroidism treatment is working properly. […] Long-term use of parathyroid hormone injections may cause osteosarcoma, a type of bone cancer. For this reason, healthcare providers dont generally prescribe it to treat hypoparathyroidism unless its absolutely necessary.

• #50 Addressing Unmet Needs: Novel Therapies in the Treatment of Adult Hypoparathyroidism – Endocrinology Advisor

  https://www.endocrinologyadvisor.com/cch/hypoparathyroidism-parathyroid-hormone-palopegteriparatide-calcium-vitamin-d/

  Conventional hypoparathyroidism (hypoPT) therapy of calcium and vitamin D replacement corrects hypocalcemia but not hyperphosphatemia. As a result, patients are left with debilitating symptoms due to high phosphate and calcium phosphate levels. […] Recombinant parathyroid hormone (PTH) therapy addresses the full scope of symptoms associated with hypoPT, yet it is currently only approved as a second-line therapy due to past concerns regarding increased osteosarcoma risks. […] Long-term follow-up studies in combination with current phase 3 study results reveal that osteosarcoma is not a major concern with recombinant PTH therapy. This treatment option lowers serum phosphate levels and improves well-being, function, and quality of life (QOL). […] Just giving conventional therapy does not address the long-term complications of hypoPT and may, in fact, exacerbate them.

• #51 Hypoparathyroidism – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441899/

  Hypoparathyroidism treatment primarily consists of correcting calcium, vitamin D, and magnesium deficiencies with supplementation. […] Within the last several years, recombinant human parathyroid hormone became available and is currently used as replacement therapy in patients unresponsive to supplementation. […] In stable patients diagnosed with hypoparathyroidism after neck surgeries (eg, thyroidectomy), the recommended standard treatment is oral elemental calcium 2 to 3 g and calcitriol .5 to 1.5 g daily. […] Long-term PTH deficiency treatment also involves supplementation with calcium and vitamin D to keep serum calcium levels at 8 to 9 mg/dL. […] While most patients with hypoparathyroidism are still treated with calcitriol and calcium, selected patients who are more difficult to control with standard therapy can be treated with parathyroid hormone replacement.

• #52 SciELO Brazil – Diagnosis and treatment of hypoparathyroidism: a position statement from the Brazilian Society of Endocrinology and Metabolism Diagnosis and treatment of hypoparathyroidism: a position statement from the Brazilian Society of Endocrinology

  https://www.scielo.br/j/aem/a/bZ5f5XXPqbDDBzw84kFVpGg/

  Maintenance of calcium concentrations in the long term has been achieved with the use of vitamin D or its active form, calcitriol, associated with oral calcium salts. […] The use of PTH and its derivatives has been tested with some success in the treatment of hypoparathyroidism, and the use of PTH (1-84) has been approved by American and European agencies (FDA and EMA). […] Treatment of hypoparathyroidism during pregnancy and lactation requires special care and more frequent control for dose adjustment, which must be individualized. […] The chronic complications of hypoparathyroidism are related to the disease progression and its treatment and include renal, ocular, cardiovascular, bone, and neuropsychiatric manifestations. Monitoring these complications is recommended.

• #53 How is hypoparathyroidism treated?

  https://www.medicalnewstoday.com/articles/hypoparathyroidism-treatment

  More recently, a prodrug version of PTH known as palopegteriparatide (Yorvipath) received approval for the treatment of hypoparathyroidism. This new drug is thought to be more stable than previous forms of PTH used in replacement therapy, so it helps keep PTH levels within the target range for longer. […] Healthcare professionals do not currently recommend PTH replacement therapy during pregnancy. […] In some cases, medications can be helpful, but evidence supporting their use is limited so far. It is not clear whether all people with hypoparathyroidism will benefit from PTH replacement therapy.

• #54

  https://www.healio.com/news/endocrinology/20240415/the-evolving-landscape-of-managing-hypoparathyroidism

  It is also important to stay up-to-date on the evolving treatment landscape. An FDA approval decision on a new parathyroid hormone replacement therapy for hypoparathyroidism is expected this year. If approved, consider how a new parathyroid hormone replacement therapy option may provide benefit to symptomatic patients who experience hypocalcemia, hyperphosphatemia, CKD, hypercalciuria and poor quality of life. Replacing the missing hormone may also be the preferred therapeutic option for patients with gastrointestinal disorders associated with calcium malabsorption and those with low adherence and/or intolerance of large doses of conventional therapy.

• #55 Hypoparathyroidism – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hypoparathyroidism/symptoms-causes/syc-20355375

  Hypoparathyroidism is an uncommon condition in which the body produces abnormally low levels of parathyroid hormone (PTH). parathyroid hormone (PTH) is key to regulating and maintaining a balance of two minerals in the body calcium and phosphorus. […] Supplements to bring calcium and phosphorus levels into a normal range treat the condition. Depending on the cause of hypoparathyroidism, you’ll likely need to take supplements for life. Sometimes parathyroid hormone replacement is needed if supplements alone are not enough to bring levels into a normal range. […] Accurate diagnosis and treatment might prevent these complications or keep them from getting worse. But once they occur, taking calcium and vitamin D usually doesn’t reverse the damage. Irreversible complications include: […] If you’re scheduled to have thyroid or neck surgery, talk to your surgeon about the risk of damage to your parathyroid glands during the procedure. Your health care provider may choose to test your calcium, parathyroid hormone and vitamin D levels and have you begin taking supplements if needed before surgery.

• #56 Hypoparathyroidism – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hypoparathyroidism/symptoms-causes/syc-20355375

  Parathyroid autotransplantation may be an option to reduce the chances of postoperative hypoparathyroidism. The surgeon works to preserve parathyroid tissue in the neck during the procedure. However, occasionally the surgeon may need to move parathyroid tissue to another area of the body, such as the arm or the chest muscle. Transplanted parathyroid tissue does not always function.

• #57 Hypoparathyroidism – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/parathyroid-disorders/hypoparathyroidism

  Hypoparathyroidism is a deficiency of parathyroid hormone often caused by an autoimmune disorder or by iatrogenic damage or removal of the parathyroid glands during thyroidectomy or parathyroidectomy. […] Treatment includes calcium and vitamin D supplementation. […] In transient hypoparathyroidism after thyroidectomy or partial parathyroidectomy, supplemental oral calcium may be sufficient: 1 to 2 g of elemental calcium/day may be given as calcium gluconate (90 mg elemental calcium/1 g) or calcium carbonate (400 mg elemental calcium/1 g). […] Prolonged parenteral administration of calcium may be necessary postoperatively; intravenous supplementation with as much as 1 g/day of elemental calcium (eg, 111 mL/day of calcium gluconate, which contains 90 mg elemental calcium/10 mL) may be required for 5 to 10 days before oral calcium and vitamin D are sufficient.

• #58 New Hypoparathyroidism Guidelines and Emerging PTH Replacement Therapies for Improved Patient Outcomes – UCSF MedConnection

  https://medconnection.ucsfhealth.org/news/new-hypoparathyroidism-guidelines-and-emerging-pth-replacement-therapies-for-improved-patient-outcomes

  New guidelines from the Second International Workshop on the Evaluation and Management of Hypoparathyroidism provide clinicians with the latest evidence-based recommendations for the prevention, diagnosis and management of this rare disease. […] The new guidelines cover: […] Managing patients with hypoparathyroidism first-line treatments and PTH therapy. […] For patients whose disease isnt well controlled by these first-line treatments, PTH therapy is a promising option but not yet the standard of care. […] The guidelines provide a framework for patients who arent well controlled on conventional management and who might be candidates for injectable PTH therapy, Shoback said. […] UCSF researchers, including transplant surgeon Peter G. Stock, MD, and endocrine surgeon Julie Ann Sosa, MD, MA, FACS, chair of the UCSF Department of Surgery and president of the American Thyroid Association, are investigating parathyroid allotransplantation as a potential treatment for severe hypoparathyroidism. […] We provide our patients with a high level of specialty care, Shoback said.

• #59 Getting Back to Normal: Options for Treating Hypoparathyroidism – Endocrine News

  https://endocrinenews.endocrine.org/getting-back-to-normal-options-for-treating-hypoparathyroidism/

  Hypoparathyroidism can be a debilitating disorder, and treatment can increase the risk of long term complications and is difficult to follow due to the very large number of calcium and active vitamin D pills needed every day. […] Clinicians are investigating a prodrug that replaces parathyroid hormone in patients with hypoparathyroidism, and the results so far have been promising. […] Clinicians should be up to date on the latest guidelines, published in late 2022. Conventional treatment remains the first-line therapy, but PTH should be considered if conventional therapy fails. […] Khan says that 95% of participants in this current clinical trial were able to come off of active vitamin D, while stabilizing calcium and bone density with palopegteriparatide. This is really, really reassuring data, and its nice to be able to replace PTH, be able to normalize calcium levels, be able to correct the urine calcium, correct the phosphate levels, improve quality of life, she says.

• #60 Hypoparathyroidism Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/122207-treatment

  Treatment of patients with hypoparathyroidism involves correcting the hypocalcemia by administering calcium and vitamin D. […] Palopegteriparatide (Yorvipath) is a prodrug of the parathyroid hormone analog PTH(1-34) and is commercially available in the United States for treatment of hypoparathyroidism in adults. It is administered as a subcutaneous injection given once daily. Similar to endogenous PTH, PTH(1-34) released from palopegteriparatide raises serum calcium and reduces serum phosphate, thus maintaining extracellular calcium and phosphate homeostasis. […] Guidelines on chronic hypoparathyroidism by the European Society of Endocrinology, released in 2015, are below: Consider a diagnosis of chronic hypoparathyroidism (HypoPT) in a patient with hypocalcemia and inappropriately low parathyroid hormone (PTH) levels.

• #61 SciELO Brazil – Diagnosis and treatment of hypoparathyroidism: a position statement from the Brazilian Society of Endocrinology and Metabolism Diagnosis and treatment of hypoparathyroidism: a position statement from the Brazilian Society of Endocrinology

  https://www.scielo.br/j/aem/a/bZ5f5XXPqbDDBzw84kFVpGg/

  An update on the recent scientific literature addressing hypoparathyroidism is presented to serve as a basis for the diagnosis and treatment of this condition in Brazil. […] Current standard treatment of low PTH levels comprising vitamin D analogs and calcium supplementation is challenging as it does not involve replacing the missing hormone. […] The objective of this document is to answer routine questions and serve as a guideline for endocrinologists and clinicians in Brazil. […] Treatment of hypoparathyroidism is aimed at correcting hypocalcemia and hyperphosphatemia, reducing symptoms, and preventing chronic complications resulting from the disease or its treatment. […] The treatment goal is to maintain the total calcium close to the lower normal range. […] Acute manifestations threatening the patients lives such as tetanic seizures, laryngospasm or bronchospasm, seizures, bradycardia, prolongation of the QT interval, or congestive heart failure, require urgent treatment with intravenous calcium.

• #62 Treatment options in hypoparathyroidism – Archives of Endocrinology and Metabolism

  https://www.aem-sbem.com/article/treatment-options-in-hypoparathyroidism/

  Hypoparathyroidism remains the single endocrine deficiency disease that is not habitually treated with the missing hormone. […] In this article, we aim to provide a review of the conventional approach and the novel therapies as well as an overview of the perspectives on the treatment of this rare condition. […] Conventional treatment involves calcium salts and vitamin D analogs. […] Thiazide diuretics can be used to reduce hypercalciuria in some cases. […] The use of PTH analogs is a new approach despite the limitation of high cost. […] Studies have included modified PTH molecules, calcilytics, microencapsulation of human parathyroid cells, and allotransplantation.

• #63 Hypoparathyroidism – EnteraBio

  https://enterabio.com/hypoparathyroidism/

  Historically, standard treatment for hypoparathyroidism includes calcium supplements, calcitriol or active vitamin D analogs and occasionally phosphate binders, the chronic use of which may result in serious side effects and significant costs to patients and healthcare systems. […] Enteras EB612 is the first oral formulation of PTH (1-34) hormone replacement treatment, that may have inherent advantages to injectable forms, enabling flexibility for titration and individualized treatment.

• #64 Treatment of Hypoparathyroidism by Re-Establishing the Effects of Parathyroid Hormone

  https://www.e-enm.org/journal/view.php?number=2480

  A phase 3 study demonstrated maintenance of normocalcemia in patients with chronic HypoPT, with no need for conventional therapy. Furthermore, this treatment lowers urinary calcium and improves QoL. […] Another long-acting PTH analog with effects on the parathyroid hormone receptor (eneboparatide) is currently being tested in a phase 3 trial. […] All in all, improved treatment options are on the way that will likely take the treatment of HypoPT to the next level. […] Despite normalizing plasma calcium levels, thereby alleviating severe symptoms of hypocalcemia, conventional treatment of HypoPT with active vitamin D and calcium supplements is associated with unpredictable fluctuations in plasma calcium levels, hypercalciuria, and several complications, including an increased risk of impaired kidney function and impaired QoL. Substitution with the missing hormone using rhPTH(1-84) or PTH(1-34) has been shown to reduce the need for conventional therapy; however, due to the short duration of action, replacement therapy with these analogues is not ideal. Palopegteriparatide is a prodrug with sustained release of PTH(1-34) designed to provide stable PTH levels in the physiological range for 24 hours/day and has recently been approved for treatment of chronic HypoPT in Europe. Treatment with eneboparatide and encaleret also seems to cause long-acting effects on the calcium-PTH axis, and phase 3 clinical trials are currently ongoing aiming to demonstrate a normalization of calcium homeostasis in response to treatment of patients with chronic HypoPT.

• #65

  https://link.springer.com/article/10.1007/s12020-024-03807-2

  Hypoparathyroidism is defined by hypocalcemia with inappropriately normal or low parathyroid hormone levels. The current standard treatment consists of lifelong calcium and/or vitamin D supplementation. Even while on stable treatment regimens, hypoparathyroid patients might still suffer from symptoms that can negatively impact their quality of life. […] Patients with hypoparathyroidism receiving standard treatment report impairments in quality of life. The reasons for these impairments are probably multifaceted, making regular monitoring and the inclusion of various professionals necessary. […] The standard treatment consists of lifelong calcium and/or vitamin D supplementation with regular monitoring, but this treatment does not restore the regular calcium/phosphorus homeostasis. […] HypoPT patients receiving standard treatment report impairments in QoL compared to norm populations or matched controls. […] Compared to norm populations or clinical controls, patients with hypoPT on standard treatment report impairments in QoL in various domains. The potential factors influencing QoL are most likely multifaceted and require regular monitoring as well as the inclusion of different professions.

• #66 Getting Back to Normal: Options for Treating Hypoparathyroidism – Endocrine News

  https://endocrinenews.endocrine.org/getting-back-to-normal-options-for-treating-hypoparathyroidism/

  Treatment with TransCon PTH in this clinical trial showed the positive physiological effects on bone in patients treated for the full year as well as in those switching from placebo after the 26-week blinded period. […] Khan is happy to report that palopegteriparatide has improved patients mental health as well. […] And if theyre not doing well, Khan continues, if their calcium levels are fluctuating, their cognition is poor, and theyre having complications or kidney stones or decline in renal function, switch to PTH, and dont neglect the fact that we do have valuable treatment options available.

• #67 Addressing Unmet Needs: Novel Therapies in the Treatment of Adult Hypoparathyroidism – Endocrinology Advisor

  https://www.endocrinologyadvisor.com/cch/hypoparathyroidism-parathyroid-hormone-palopegteriparatide-calcium-vitamin-d/

  PTH therapy has been shown to improve QOL, reduce pill burden, and lower serum phosphate levels while maintaining serum calcium in the normal reference range. It is indeed a major advance in the treatment of hypoPT. […] This molecule can provide circulating PTH levels in the normal reference range throughout the 24-hour time period and can normalize serum calcium while lowering serum phosphate and the 24-hour urine calcium. […] It allows patients to stop active vitamin D and reduce the calcium supplement to 600 mg or less daily in 93% of patients. […] Patients with hypoPT do have significantly impaired QOL due to multiple factors. The wide fluctuations in serum calcium are disabling in many patients and the neurologic manifestations with numbness and tingling in the face, hands, and feet can prevent an individual from engaging in a meaningful work schedule.

• #68

  https://www.healio.com/news/endocrinology/20240415/the-evolving-landscape-of-managing-hypoparathyroidism

  Approximately 77,000 people in the U.S. have hypoparathyroidism due to absent or subphysiological levels of parathyroid hormone. […] Endocrinologists must stay up to date on the evolving treatment landscape and management guidelines for hypoparathyroidism. […] Conventional therapy, composed of calcium supplements (calcium citrate or calcium carbonate) and active vitamin D (calcitriol), is designed to raise albumin-adjusted serum calcium to the lower half of or just below the normal reference range. This is intended to alleviate symptoms of hypocalcemia while avoiding hypercalciuria and hyperphosphatemia. […] Parathyroid hormone replacement can reduce pill burden, improve adherence and prevent end-organ damage from complications related to high calcium supplementation. […] Hypoparathyroidism is a rare disorder with limited therapeutic options. For clinicians managing patients with hypoparathyroidism, the 2022 international guidelines, which are based on the most up-to-date clinical evidence, serve as an excellent practice resource.

• #69

  https://www.healio.com/clinical-guidance/hypoparathyroidism/treatment-objectives-treatment-options

  The primary objective of hypoparathyroidism (hypoPT) treatment is to correct symptomatic hypocalcemia and try to achieve a serum calcium which is just below the normal reference range or in the low normal reference range. It is also to normalize phosphate and correct hypercalciuria in order to minimize the risk of renal complications. Other treatment objectives include improving quality of life (QoL) and reducing the risk of multisystem complications arising from hypoPT. […] Patients with hypoPT who present with severe acute signs and symptoms of hypocalcemia, including tetany, carpopedal spasm, seizures, bronchospasm, laryngospasm, or cardiac arrhythmias, require emergency room assessment and administration of intravenous (IV) calcium salts. […] Continuous infusion of calcium salts may be necessary to prevent recurrent hypocalcemia. A typical approach involves infusing 10 ampules of 10% calcium gluconate in 1L of 5% dextrose in water or 0.9% saline at a starting rate of 50 mL per hour, with frequent monitoring of serum calcium levels. Administered over 4-6 hours, 10 mL/kg of this solution is expected to raise serum calcium levels by 0.3 to 0.5 mmol/L (or 1.2 to 2.0 mg/dL). […] Adverse events (AE) which may occur with administration of IV calcium include development of a chalky taste, hot flushes, and peripheral vasodilation.

• #70 Getting Back to Normal: Options for Treating Hypoparathyroidism – Endocrine News

  https://endocrinenews.endocrine.org/getting-back-to-normal-options-for-treating-hypoparathyroidism/

  Treatment with TransCon PTH in this clinical trial showed the positive physiological effects on bone in patients treated for the full year as well as in those switching from placebo after the 26-week blinded period. […] Khan is happy to report that palopegteriparatide has improved patients mental health as well. […] And if theyre not doing well, Khan continues, if their calcium levels are fluctuating, their cognition is poor, and theyre having complications or kidney stones or decline in renal function, switch to PTH, and dont neglect the fact that we do have valuable treatment options available.

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