Alternative treatment of resistant hypoparathyroidism by intermittent infusion of teriparatide using an insulin pump: A case report

Pekkolay, Zafer; Kılınç, Faruk; Soylu, Hikmet; Balsak, Belma Özlem Tural; Güven, Mehmet; Tuzcu, Şadiye Altun; Kara, Ali Veysel; Tuzcu, Alpaslan

doi:10.5606/tftrd.2019.2718

Cited by 6 publications

(6 citation statements)

References 16 publications

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“…In this case, intermittent teriparatide infusion using an insulin pump corrected hypocalcemia. 15 Similar other case reports with postsurgical hypoparathyroidism resistant to standard treatment and subcutaneous injection of teriparatide (once daily or multiple injections) were successfully treated with continuous teriparatide delivery by a pump. [16][17] In total, teriparatide therapy via pump infusion was found to have less fluctuation in serum calcium, long term stabilization of calcium and phosphate, decreased urinary calcium, and significant reduction of PTH total daily dosage as it mimicked the physiological response of natural endothelial parathyroid hormone found in the human body.…”

Section: Case Reportmentioning

confidence: 69%

Use of parathyroid hormone analog (Teriparatide) in patients with chronic hypoparathyroidism after total thyroidectomy: a case report

Rai

Karki

Paudel

et al. 2020

Jour of Diab and Endo Assoc of Nepal

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Background: Hypoparathyroidism and hypocalcemia is a common postoperative complication, after total thyroidectomy due to thyroid cancer. Standard treatment with supplementation of calcium and vitamin D analogs, usually treat this condition. In some patients, hypoparathyroidism is refractory to standard treatment plus intermittent calcium infusions with persistent low serum calcium levels and associated clinical complications. Attempts have been made to add recombinant human parathormone (rhPTH) to the treatment schedule. To our knowledge, this is the first time that we encounter a patient suffering from treatment-refractory postsurgical hypoparathyroidism who was treated with teriparatide. Case presentation: Male (31 years) with postoperative hypoparathyroidism, after total thyroidectomy due to papillary thyroid cancer, several weeks after the surgery still required intermittent intravenous calcium infusions because of tetany symptoms. He had persistent hypocalcemia despite oral treatment with up to 1 ug calcitriol and 4 g calcium per day necessitating additional intravenous administration of calcium gluconate intermittently. This time, Teriparatide treatment was introduced at once daily 50 micrograms (mcg) subcutaneous injection, while doses of calcium and calcitriol were gradually decreased depending on the response of serum total and ionized calcium taken periodically, which resulted in total resolution of hypocalcemia symptoms and the achievement and maintenance of laboratory normocalcaemia in just 5 days. Conclusion: Treatment refractory chronic hypoparathyroidism may be seen in some cases after total thyroidectomy. Furthermore, the use of recombinant human parathyroid hormone analog (Teriparatide) allows for the control of recurrent hypocalcemia reducing the daily dosage of calcium and vitamin D. Finally, regular intravenous calcium administration was no more needed.

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Section: Case Reportmentioning

confidence: 69%

Use of parathyroid hormone analog (Teriparatide) in patients with chronic hypoparathyroidism after total thyroidectomy: a case report

Rai

Karki

Paudel

et al. 2020

Jour of Diab and Endo Assoc of Nepal

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“…Paratiroit allotransplantasyonu (PA) ise alternatif ve hastalığı tedavi edici tek yöntem olarak görülmektedir (8) hücre izole edilmiştir. İzole edilen PKMH'lerine ait Alıcı 1 (A1) için %93,4 canlılıkta 14x10 6 hücre, Alıcı 2 (A2) için %96 canlılıkta 12x10 6 hücre, Alıcı 3 (A3) için %89,9 canlılıkta 7x10 6 ve Alıcı 4 (A4) için %91,2 canlılıkta 9,7x10 6 sayıda hücre elde edilmiştir (Şekil 1).…”

Section: Introductionunclassified

“…Paratiroit dokusundan izole edilen donör grubuna ait hücrelerden 3x10 6 hücre/kuyu başı olmak üzere 48 kuyulu plaka içine ekilmiştir. Ayırıcı bölme olmadan, aynı kuyu içerisine alıcı grubuna ait izole edilen 1,5x10 6 sayıda PKMH ekilmiştir.…”

Section: Introductionunclassified

“…Kalıcı Hipoparatiroidizm (KH), düşük kalsiyum ve düşük parathormon (PTH) seviyeleri ile karakte-rize bir hastalıktır. KH'nin en yaygın sebebi tiroit cerrahisi sırasında paratiroit bezlerinin alınması ya da kanlanmasının hasar görmesidir (6). KH' de en sık görülen komplikasyonlar ise: zayıflık, kas fonksiyon kaybı, miyozit, fasiit, katarakt diş malformasyonları ve nefropatidir.…”

Section: Introductionunclassified

“…KH nadiren hayati tehlikeye sebep olan bir durum olduğundan, tedavi aşamasında immünsüpresif uygulanması tercih edilmez (8). Tüm bu alternatif süreçlere rağmen, günümüzde hipoparatiroidizm tedavisine yönelik standart bir yaklaşım bulunmamaktadır (6).…”

Section: Introductionunclassified

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Periferik kan mononükleer hücrelerin primer paratiroit dokusu hücreleri ile ko-kültürünün verimliliği

Hasanoğlu¹,

Göncü²,

Yücesan³

2020

JARHS

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ÖZ Organ yetmezliğinde, nakil öncesi uygulanan immün testler ekonomik anlamda maliyetli ve uzman ekip gözetiminde uygulanan hassas testlerdir. Uygulaması görece daha kolay olan in vitro ko-kültür modelleri ile daha ekonomik ve uygulama kolaylığı olan bir yöntem geliştirilmesi hedeflenmiştir. Kalıcı hipoparatiroidi hastalarına ait periferik kan mononükleer hücreleri (n=4) ile iki farklı donöre ait paratiroit hücresinin ayırıcı bir bariyer olmadan ve bariyer kullanılarak ko-kültüre edilmesiyle bir model oluşturulmuştur. Parathormon ve hücre sayım takibi 24 ve 72. saatlerde gerçekleştirilmiştir. İki ayrı paratiroit hücre grubunda parathormon seviyesi anlamlı şekilde artarken, hücre sayısı anlamlı şekilde her iki grupta da azalmıştır. Kontrol grubu ile karşılaştırıldığında ise ayırıcı bariyer kullanıldığı ve kullanılmadığı her iki durumda da periferik kan mononükleer hücreleri yabancı paratiroit hücrelerine karşı anlamlı bir değişim göstermemiştir. Bu çalışmada uygulanan ko-kültür modeli, manipülasyonu diğer hassas testlere göre daha kolaydır. Temelde, nakil sağ kalımının öngörülmesi sürecinin daha az maliyetle belirlenebilmesi için gerçekleştirilmiştir. Fakat uygulanan iki ayrı ko-kültür modeli hem ayırıcı bir bariyer eşliğinde hem de ayırıcı bir bariyer olmadan paratiroit hücreleri ve PKMH için anlamlı bir farklılık oluşturmamıştır. İlerleyen çalışmalarda daha hassas testlerin uygulanarak sağ kalım öngörülmesi için farklı yöntemlerin denenmesi hedeflenmektedir.

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Teriparatide administration by the Omnipod pump: preliminary experience from two cases with refractory hypoparathyroidism

et al. 2022

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38Context: Hypoparathyroidism (hypoPTH) in adults is mainly due to total thyroidectomy. 39Conventional therapies (calcium, active vitamin D) can fail to normalize calcemia, expose the 40 patient to hypercalciuria and impact quality-of-life. Human parathormone (PTH) replacement 41 therapy is a suitable option in these cases, although few clinical reports have been published so 42 far. 43 Methods: we describe two cases of patients with refractory postsurgical hypoPTH, in whom 44 subcutaneous infusion of recombinant PTH (teriparatide) through the Omnipod® pump was 45 initiated after failure of all other therapeutic options. Besides, we performed a review of 46 literature of hypoPTH cases treated by continuous infusion of teriparatide. 47 Results: two women aged 46 and 61yo failed to normalize calcemia either with conventional 48 treatments (calcium 8g/d + calcitriol 9mcg/d and calcium 5g/d + calcitriol 12mcg/d) or with 49 thrice-daily subcutaneous injections of teriparatide. As a last resort, teriparatide infusion via 50 Omnipod® device normalized their calcemia and allowed calcium/vitamin D withdrawal, with 51 average teriparatide dose of 23 and 32 mcg/d, respectively. The flow of teriparatide was adapted 52 according to a protocol based on measured calcemia, under medical supervision. In the 53 literature, 15 adult cases (13 women, mean age 44.5 ± 5.2 yo) are reported. HypoPTH was 54 consecutive to surgery in all of them. Mean dose of teriparatide administered was 25 ± 6 mcg/d 55 with improvement of calcemia level and quality-of-life in all patients. 56 Conclusion: Continuous administration of teriparatide through Omnipod® appears as an 57 efficient therapeutic option in refractory hypoPTH, whose administration to the patient can be 58 assisted by medically-supervised protocol.

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Alternative treatment of resistant hypoparathyroidism by intermittent infusion of teriparatide using an insulin pump: A case report

Cited by 6 publications

References 16 publications

Use of parathyroid hormone analog (Teriparatide) in patients with chronic hypoparathyroidism after total thyroidectomy: a case report

Use of parathyroid hormone analog (Teriparatide) in patients with chronic hypoparathyroidism after total thyroidectomy: a case report

Periferik kan mononükleer hücrelerin primer paratiroit dokusu hücreleri ile ko-kültürünün verimliliği

Teriparatide administration by the Omnipod pump: preliminary experience from two cases with refractory hypoparathyroidism

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