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Hypoparathyroidism

Last reviewed: 12 Nov 2024
Last updated: 15 Nov 2024
15 Nov 2024

FDA approves palopegteriparatide for hypoparathyroidism in adults

The US Food and Drug Administration (FDA) has approved palopegteriparatide for the treatment of hypoparathyroidism in adults. It is the first and only treatment approved for hypoparathyroidism.

Palopegteriparatide is a prodrug consisting of parathyroid hormone (1‐34) conjugated to a methoxypolyethylene glycol (mPEG) carrier.

In a 26-week phase 3, double-blind trial of adults with chronic hypoparathyroidism, 79% of patients randomized to palopegteriparatide, and 5% to placebo, maintained normal calcium levels without needing conventional therapy (i.e., active vitamin D and high doses of calcium).[37]

Palopegteriparatide is approved in Europe for the treatment of chronic hypoparathyroidism in adults.

See Management: emerging

Original source of update

Summary

Definition

History and exam

Key diagnostic factors

  • history of thyroid, parathyroid, or laryngeal surgery
  • chronic alcoholism
  • malnutrition, malabsorption, diarrhea
  • muscle twitches, spasms, cramps
  • paresthesias, numbness, tingling
  • poor memory, slowed thinking
  • Chvostek sign
  • convulsions
  • irregular heart beat, tachycardia
  • Trousseau sign
Full details

Other diagnostic factors

  • anxiety
  • dry hair, brittle nails
  • cataracts
  • history of mucocutaneous candidiasis
  • history of chronic transfusions in patients with thalassemia
  • dyspnea
  • laryngeal spasm
Full details

Risk factors

  • thyroid surgery
  • parathyroid surgery
  • hypomagnesemia
  • moderate and chronic maternal hypercalcemia (neonatal hypocalcemia)
  • autosomal dominant conditions (e.g., mutations in CASR, GATA3)
  • hereditary hemochromatosis
  • transfusional iron overload in thalassemia
  • Wilson disease
  • metastatic cancer
Full details

Diagnostic tests

1st tests to order

  • serum calcium
  • plasma intact PTH
  • serum albumin
  • serum magnesium
  • serum 25-hydroxyvitamin D
  • serum phosphorus
  • serum creatinine
  • ECG
Full details

Tests to consider

  • 24-hour urine calcium, creatinine
  • 24-hour magnesium, creatinine
  • liver function tests
  • arterial blood gases (ABGs)
  • serum free thyroxine, thyrotropin
  • morning cortisol and adrenocorticotropin (ACTH) stimulation testing
  • complete blood count
  • serum iron, transferrin, ferritin
  • serum copper
  • ophthalmologic exam
  • audiology
  • renal imaging
  • autoantibodies to type 1 interferon or 21-hydroxylase
  • gene sequencing
Full details

Treatment algorithm

INITIAL

severe symptomatic hypocalcemia (albumin-corrected serum total calcium <7.5 mg/dL [<1.88 mmol/L])

ACUTE

asymptomatic temporary postoperative hypocalcemia

ONGOING

chronic hypoparathyroidism

Contributors

Authors

Dolores Shoback, MD

Professor of Medicine

University of California San Francisco

Endocrine Research Unit

San Francisco VA Medical Center

San Francisco

CA

Disclosures

DS declares that her institution receives research money from Ascendis Pharmaceuticals to conduct a clinical trial in hypoparathyroid patients on which she is the Principal Investigator. This company is testing a new treatment for hypoparathyroidism. DS has participated in an advisory board for Ascendis (Dec 2022) to review data on this new treatment.

Quan-Yang Duh, MD, FACS

Professor of Surgery

Section of Endocrine Surgery

University of California San Francisco

San Francisco

CA

Disclosures

QYD declares that he has no competing interests.

Acknowledgements

Professors Dolores Shoback and Quan-Yang Duh would like to gratefully acknowledge Professor Ronald Merrell, a previous contributor to this topic.

Disclosures

RM declares that he has no competing interests.

Peer reviewers

Wail Malaty, MD

Adjunct Clinical Professor

Department of Family Medicine

University of North Carolina

Chapel Hill

NC

Disclosures

WM declares that he has no competing interests.

  • Hypoparathyroidism images
  • Differentials

    • Hypomagnesemia
    • Hypoalbuminemia
    • Chronic kidney disease
    More Differentials
  • Guidelines

    • Evaluation and management of hypoparathyroidism: summary statement and guidelines
    • Standards of care for hypoparathyroidism in adults: a Canadian and international consensus
    More Guidelines
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