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

Abstract

CONTEXT:

Hypoparathyroidism (hypoPTH) in adults is mainly due to total thyroidectomy. Conventional therapies (calcium, active vitamin D) can fail to normalize calcemia, expose the patient to hypercalciuria and impact quality-of-life. Human parathormone (PTH) replacement therapy is a suitable option in these cases, although few clinical reports have been published so far.

METHODS:

We describe two cases of patients with refractory postsurgical hypoPTH, in whom subcutaneous infusion of recombinant PTH (teriparatide) through the Omnipod® pump was initiated after failure of all other therapeutic options. Besides, we performed a review of literature of hypoPTH cases treated by continuous infusion of teriparatide.

RESULTS:

Two women aged 46 and 61 years old failed to normalize calcemia either with conventional treatments (calcium 8 g/day + calcitriol 9 mcg/day and calcium 5 g/day + calcitriol 12 mcg/day) or with thrice daily subcutaneous injections of teriparatide. As a last resort, teriparatide infusion via Omnipod® device normalized their calcemia and allowed calcium/vitamin D withdrawal, with average teriparatide dose of 23 and 32 mcg/day, respectively. The flow of teriparatide was adapted according to a protocol based on measured calcemia, under medical supervision. In the literature, 15 adult cases (13 women, mean age 44.5 ± 5.2 years old) are reported. HypoPTH was consecutive to surgery in all of them. Mean dose of teriparatide administered was 25 ± 6 mcg/day with improvement of calcemia level and quality-of-life in all patients.

CONCLUSIONS:

Continuous administration of teriparatide through Omnipod® appears as an efficient therapeutic option in refractory hypoPTH, whose administration to the patient can be assisted by medically-supervised protocol.

• Authors: Karine Aouchiche, Rachel Reynaud, Vincent Amodru, Thierry Brue, Thomas Cuny
• Journal: Endocrine (Endocrine) Vol. 76 Issue 1 Pg. 179-188 (04 2022) ISSN: 1559-0100 [Electronic] United States
• PMID: 34984624 (Publication Type: Journal Article, Review)
• Copyright: © 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Chemical References

• Parathyroid Hormone
• Teriparatide
• Vitamin D
• Calcitriol
• Calcium

Topics

• Adult
• Calcitriol (therapeutic use)
• Calcium (therapeutic use)
• Female
• Humans
• Hypercalcemia
• Hypoparathyroidism (drug therapy)
• Middle Aged
• Parathyroid Hormone (therapeutic use)
• Teriparatide (therapeutic use)
• Vitamin D (therapeutic use)