Synthetic human parathyroid hormone 1-34 vs calcitriol and calcium in the treatment of hypoparathyroidism

K. K. Winer, J. A. Yanovski and G. B. Cutler Jr
Developmental Endocrinology Branch of the National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-1862, USA.

OBJECTIVE: To test the hypothesis that treatment with human parathyroid hormone 1-34 (PTH 1-34) can maintain normal serum calcium without hypercalciuria in patients with hypoparathyroidism. DESIGN: Randomized crossover trial lasting 20 weeks. Each 10-week arm consisted of a 2-week inpatient dose-adjustment phase followed by an 8-week outpatient phase. SETTING: Tertiary care center. PATIENTS: A total of 10 patients with hypoparathyroidism were enrolled consecutively over a 15-month period. Half of the patients were prior National Institutes of Health patients, and the other 5 patients were referred from outside physicians. INTERVENTIONS: A dose of PTH 1-34 was administered each morning by subcutaneous injection. Calcitriol was given orally twice daily with supplemental calcium carbonate. MAIN OUTCOME MEASURES: Serum and urine calcium and phosphorus levels. RESULTS: Once-daily treatment with PTH 1-34 maintained serum calcium in the normal range with decreased urine calcium excretion (P<.05 at 2 weeks and P<.Ol at 10 weeks) compared with calcitriol treatment. Biochemical markers of bone turnover increased significantly (P<.Ol at 10 weeks) during PTH 1-34 treatment. CONCLUSIONS: Treatment of hypoparathyroidism with PTH 1-34 reduces urine calcium excretion compared with treatment with calcitriol and calcium.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Hypoparathyroidism: Is It Time for Replacement Therapy?
Horwitz and Stewart
J. Clin. Endocrinol. Metab. 2008;93:3307-3309.
FULL TEXT  

Effects of Once Versus Twice-Daily Parathyroid Hormone 1-34 Therapy in Children with Hypoparathyroidism
Winer et al.
J. Clin. Endocrinol. Metab. 2008;93:3389-3395.
ABSTRACT | FULL TEXT  

Hypoparathyroidism
Shoback
NEJM 2008;359:391-403.
FULL TEXT  

A Hypocalcemic Child with a Novel Activating Mutation of the Calcium-Sensing Receptor Gene: Successful Treatment with Recombinant Human Parathyroid Hormone
Mittelman et al.
J. Clin. Endocrinol. Metab. 2006;91:2474-2479.
ABSTRACT | FULL TEXT  

Long-Term Treatment of Hypoparathyroidism: A Randomized Controlled Study Comparing Parathyroid Hormone-(1-34) Versus Calcitriol and Calcium
Winer et al.
J. Clin. Endocrinol. Metab. 2003;88:4214-4220.
ABSTRACT | FULL TEXT  

Hyperparathyroid and Hypoparathyroid Disorders
Marx
NEJM 2000;343:1863-1875.
FULL TEXT  

Comparison of Hypocalcemic Hypercalciuria between Patients with Idiopathic Hypoparathyroidism and Those with Gain-of-Function Mutations in the Calcium-Sensing Receptor: Is It Possible to Differentiate the Two Disorders?
Yamamoto et al.
J. Clin. Endocrinol. Metab. 2000;85:4583-4591.
ABSTRACT | FULL TEXT  

A Randomized, Cross-Over Trial of Once-Daily Versus Twice-Daily Parathyroid Hormone 1-34 in Treatment of Hypoparathyroidism
Winer et al.
J. Clin. Endocrinol. Metab. 1998;83:3480-3486.
ABSTRACT | FULL TEXT  

Sporadic Hypoparathyroidism Caused by de Novo Gain- of-Function Mutations of the Ca2+-Sensing Receptor
De Luca et al.
J. Clin. Endocrinol. Metab. 1997;82:2710-2715.
ABSTRACT | FULL TEXT