Teriparatide Therapy in a 4-Month-Old With Severe Hypoparathyroidism

Abstract

Teriparatide is a human parathyroid hormone analog approved for the treatment of osteoporosis in adult patients. Its use for hypocalcemia and hypoparathyroidism in the pediatric population is described through case reports and small case series; however, larger studies that demonstrate long-term efficacy and safety are limited. At our institution, a 4-month-old premature (gestational age: 32 weeks) infant with multiple congenital anomalies, functional athymia, and severe hypoparathyroidism and receiving calcitriol, vitamin D, and calcium carbonate supplementation was initiated on subcutaneous injection of teriparatide. During the course of treatment, her calcium carbonate, vitamin D, and calcitriol supplementation requirements substantially decreased. Teriparatide effectively increased serum ionized calcium concentrations and decreased serum phosphorus concentrations in the present case-study over a 6-month period. Teriparatide was well tolerated, and no evidence of hypercalcemia was observed throughout treatment.

Management of Hypoparathyroidism

“…In these reports, rhPTH delivered by pump maintained long-term serum calcium, phosphorus, and urinary calcium levels in the normal range with substantially reduced incidence of adverse events and hospitalizations. (32,33) Management of HypoPT in infants and toddlers is described in a few case reports of emergency treatment of hypocalcemia, (37,38) long-term PTH therapy in a premature infant with DiGeorge, (76) or conventional therapy in two 2-month-old infants with GCMB2 mutations and a 6-month-old with Sanjad Sakati syndrome where intercurrent illness required escalation of vitamin D and calcium doses. (77) Genetic forms of HypoPT rarely manifest as neonatal hypocalcemia, which is more likely associated with prematurity, birth asphyxia, maternal diabetes, hypomagnesemia, metabolic alkalosis, increased phosphate load, or defects in vitamin D metabolism.…”