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Teriparatide (rhPTH) treatment in children with syndromic hypoparathyroidism

  • Patrizia Matarazzo , Gerdi Tuli EMAIL logo , Ludovica Fiore , Alessandro Mussa , Francesca Feyles , Valentina Peiretti and Roberto Lala
Published/Copyright: August 14, 2013
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 27 Issue 1-2

Abstract

Background: Subcutaneous recombinant human parathormone [rhPTH (1–34)] has been introduced for hypoparathyroidism treatment, allowing avoidance of vitamin D and calcium side effects.

Objective: Our objective was to evaluate rhPTH (1–34) safety and efficacy in pediatric patients with genetically proved syndromic hypoparathyroidism.

Methods: The study was a 2.5-year self-controlled trial on six pediatric patients (four males, two females, age 9.8±5.1 years) with syndromic hypoparathyroidism including three with autoimmune polyendocrinopathy candidiasis ectodermal dysplasia (APECED) syndrome, two with DiGeorge syndrome, and one with hypoparathyroidism-deafness-renal dysplasia syndrome. We compared patients’ clinical and biochemical outcome of conventional treatment based on oral administration of calcium (1–1.5 g/day in three doses) plus oral calcitriol (6.5–33 ng/kg per day in two to three doses) with the outcome obtained with rhPTH (1–34) (teriparatide, 12.5 μg bid). Therapy shift was conducted introducing rhPTH (1–34) while progressively withdrawing calcium and vitamin D. Blood calcium, phosphorus, alkaline phosphatase, and urinary calcium-to-creatinine ratio (mg/mg) before and during rhPTH therapy were compared.

Results: rhPTH treatment allowed complete calcium and vitamin D withdrawal in two patients, calcium withdrawal in three and reduction of vitamin D dose in two. During rhPTH (1–34), mean blood calcium, phosphorus, and alkaline phosphatase were not significantly modified, whereas significant reduction of the calciuria-to-creatininuria ratio (0.55±0.31 vs. 0.1±0.1, p=0.02) was obtained. The number of tetanic episodes was reduced in four patients during teriparatide treatment compared to conventional treatment.

Conclusion: In children with syndromic hypoparathyroidism, substitutive treatment with rhPTH (1–34) maintains adequate blood calcium levels and allows prompt normalization of urinary calcium excretion, through direct action on the kidney and through calcium and vitamin D therapy layoff.

Keywords: children; hypoparathyroidism; rhPTH; substitutive treatment
Corresponding author: Gerdi Tuli, MD, Department of Pediatric Endocrinology and Diabetology, University of Turin, Regina Margherita Children’s Hospital, Turin, Italy, Phone: +39-349-323-2854, Fax: +39-011-313-5439, E-mail:

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Received: 2013-4-22
Accepted: 2013-7-12
Published Online: 2013-08-14
Published in Print: 2014-01-01

©2014 by Walter de Gruyter Berlin Boston

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  5. Consensus, guidelines and reviews
  6. Review article
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  8. Images in pediatric endocrinology
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  18. Skeletal maturation and predicted adult height in children with premature adrenarche
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  30. Hypocalcemia in a paediatric case: from the clinical features to diagnosis
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  32. Iatrogenic acute pancreatitis due to hypercalcemia in a child with pseudohypoparathyroidism
  33. Clinical expression of familial Williams-Beuren syndrome in a Turkish family
  34. The first report of cabergoline-induced immune hemolytic anemia in an adolescent with prolactinoma
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  40. Marine-Lenhart syndrome in a young girl
  41. Novel AQP2 mutation causing congenital nephrogenic diabetes insipidus: challenges in management during infancy
  42. Letter to the Editors
  43. Mutational analysis of KISS1 and KISS1R in idiopathic central precocious puberty
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https://doi.org/10.1515/jpem-2013-0159
Keywords for this article
children; hypoparathyroidism; rhPTH; substitutive treatment

Articles in the same Issue

  1. Masthead
  2. Masthead
  3. Editorials
  4. Editorial
  5. Consensus, guidelines and reviews
  6. Review article
  7. Adaptation of glucose metabolism to fasting in young children with infectious diseases: a perspective
  8. Images in pediatric endocrinology
  9. Coexistence of testicular microlithiasis with parathyroid adenoma in an obese child
  10. Original articles
  11. Remission of hypertension and electrolyte abnormalities following renal transplantation in a patient with apparent mineralocorticoid excess well documented throughout childhood
  12. Effects of metformin in children and adolescents with Prader-Willi syndrome and early-onset morbid obesity: a pilot study
  13. Glycemic control in familial vs. sporadic type 1 diabetes patients over 5 years
  14. Clinical and laboratory features of temporary brittle bone disease
  15. Age of thelarche and menarche in contemporary US females: a cross-sectional analysis
  16. Teriparatide (rhPTH) treatment in children with syndromic hypoparathyroidism
  17. Retinol and retinyl palmitate in fetal mice liver: sexual dimorphism
  18. Skeletal maturation and predicted adult height in children with premature adrenarche
  19. Homozygosity for a DTDST mutation in a child with multiple epiphyseal dysplasia
  20. Body composition in young patients with galactose metabolic disorders: a preliminary report
  21. Detection of vascular risk markers in children and adolescents with type 1 diabetes
  22. X-linked recessive nephrogenic diabetes insipidus: a clinico-genetic study
  23. Factors influencing neonatal thyroid-stimulating hormone concentrations as a measure of population iodine status
  24. Pediatric idiopathic intracranial hypertension and the underlying endocrine-metabolic dysfunction: a pilot study
  25. Patient reports
  26. Hypothalamic hamartoma associated with central precocious puberty and growth hormone deficiency
  27. A pediatric patient with Cushing syndrome caused by ectopic ACTH syndrome and concomitant pituitary incidentalomas
  28. A novel genetic mutation in a Portuguese family with GCK-MODY
  29. Permanent neonatal diabetes mellitus in monozygotic twins achieving low-dose sulfonylurea therapy
  30. Hypocalcemia in a paediatric case: from the clinical features to diagnosis
  31. A rare case of osteogenesis imperfecta combined with complete tooth loss
  32. Iatrogenic acute pancreatitis due to hypercalcemia in a child with pseudohypoparathyroidism
  33. Clinical expression of familial Williams-Beuren syndrome in a Turkish family
  34. The first report of cabergoline-induced immune hemolytic anemia in an adolescent with prolactinoma
  35. Low-level hyperinsulinism with hypoglycemic spells in an infant with mosaic Turner syndrome and mild Kabuki-like phenotype: a case report and review of the literature
  36. Multiple cutaneous hemangiomas in a patient with combined pituitary hormone deficiency
  37. Premature thelarche related to fennel tea consumption?
  38. A novel insertion in the FOXL2 gene in a Chilean patient with blepharophimosis ptosis epicanthus inversus syndrome type I
  39. Zellweger syndrome: prenatal and postnatal growth failure with epiphyseal stippling
  40. Marine-Lenhart syndrome in a young girl
  41. Novel AQP2 mutation causing congenital nephrogenic diabetes insipidus: challenges in management during infancy
  42. Letter to the Editors
  43. Mutational analysis of KISS1 and KISS1R in idiopathic central precocious puberty
  44. Carotid intima media thickness and echocardiography in risk stratification of obese adolescents with non-alcoholic fatty liver disease: what is the “right” approach?
  45. Vitamin D and the heart: what is the truth?
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