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

Abstract

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.