Hypoparathyroidism medical therapy: Difference between revisions

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{{Hypoparathyroidism}}
{{Hypoparathyroidism}}
{{CMG}}; {{AE}}
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==Overview==
==Overview==
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
Pharmacologic medical therapies for hypoparathyroidism include [[Calcium supplement|calcium]] and [[Vitamin D3]] supplementation. Severe [[hypocalcemia]], a potentially life-threatening condition,  is treated as soon as possible with [[intravenous]] [[calcium]] (e.g. as [[calcium gluconate]]). Generally, a central venous catheter is recommended, as the calcium can irritate [[peripheral vein]]s and cause [[phlebitis]]. Natpara (rhPTH) is a synthetic recombinant human [[parathyroid hormone]] approved by U.S. [[FDA]] in 2015 for treatment of hypoparathyroidism.
 
OR
 
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
 
OR
 
The majority of cases of [disease name] are self-limited and require only supportive care.
 
OR
 
[Disease name] is a medical emergency and requires prompt treatment.
 
OR
 
The mainstay of treatment for [disease name] is [therapy].
 
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR
 
[Therapy] is recommended among all patients who develop [disease name].
 
OR
 
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
 
OR
 
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
 
OR
 
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
 
OR
 
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
 


==Medical Therapy==
==Medical Therapy==
Severe hypocalcemia, a potentially life-threatening condition,  is treated as soon as possible with [[intravenous]] [[calcium]] (e.g. as [[calcium gluconate]]). Generally, a central venous catheter is recommended, as the calcium can irritate [[peripheral vein]]s and cause [[phlebitis]].
*Pharmacologic medical therapies for hypoparathyroidism include [[Calcium supplement|calcium]] and [[Vitamin D3]] supplementation.<ref name="pmid26938200">{{cite journal |vauthors=Bilezikian JP, Brandi ML, Cusano NE, Mannstadt M, Rejnmark L, Rizzoli R, Rubin MR, Winer KK, Liberman UA, Potts JT |title=Management of Hypoparathyroidism: Present and Future |journal=J. Clin. Endocrinol. Metab. |volume=101 |issue=6 |pages=2313–24 |year=2016 |pmid=26938200 |pmc=5393596 |doi=10.1210/jc.2015-3910 |url=}}</ref>
*Severe hypocalcemia, a potentially life-threatening condition,  is treated as soon as possible with [[intravenous]] [[calcium]] (e.g. as [[calcium gluconate]]).
*Generally, a [[central venous catheter]] is recommended, as the [[calcium]] can irritate [[peripheral vein]]s and cause [[phlebitis]].


Long-term treatment of hypoparathyroidism is with calcium and [[Vitamin D3]] supplementation (D1 is ineffective in the absence of renal conversion). [[Teriparatide]], a synthetic form of PTH (presently registered for [[osteoporosis]]) might become the treatment of choice for PTH supplementation, although further studies are awaited.
===Hypoparathyroidism===
Management guidelines for hypoparathyroidism are as follows:
* '''1 Management of Acute hypocalcemia'''
*:'''Note(1):''' IV [[calcium]] used for marked [[hypocalcemia]] (<7.0 mg/dL), [[hypocalcemia]] associated with signs and symptoms, and if patients unable to take or absorb oral [[calcium supplement]]s.
** 1.1 '''Intravenous calcium supplementation'''
**:* Preferred regimen (1): [[Calcium gluconate]] 1 to 2 g in 50 mL of 5% [[dextrose]] over 10-20 minutes initially followed by maintenance by 50 – 100 mg/hour.
**:: '''Note(1):''' 10% [[calcium gluconate]] is used which contains 90 mg of elemental [[calcium]] per 10 mL.
**:: '''Note(2):''' 1 mg/mL solution of [[elemental calcium]] is prepared as follows: Add 11 g of [[calcium gluconate]] (110 mL ) to 890 mL [[normal saline]] or 5% [[dextrose]] water making a final volume of 1000 mL. 11 g of [[calcium gluconate]] contains 990 mg of [[elemental calcium]].
**:: '''Note(3):''' Rapid infusion of [[calcium gluconate]] should not be used as it carries serious risk of [[cardiac dysfunction]], including systolic arrest.
** 1.2 '''Parenteral vitamin D therapy'''
**:* Preferred regimen (1): [[Calcitriol]] 0.25 to 0.5 μg q12h
** 1.3 '''Intravenous Magnesium supplementation (in case of hypomagnesia)'''
**:* Preferred regimen (1): [[Magnesium sulfate]] 2g (16mEq) as 10% solution, infused over 10 -20 minutes initially, followed by 1g (8 mEq) in 100 mL infused over an hour.


 
* 2 '''Conventional therapy for hypoparathyroidism'''
 
** 2.1 '''Oral calcium'''
==Medical Therapy==
**:* Preferred regimen (1): [[Calcium carbonate]] (40% [[elemental calcium]]) '''(better absorption with meals) '''
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
**:* Alternative regimen (1): [[Calcium citrate]] (21% [[elemental calcium]]) '''(more effective in patients with [[achlorhydria]] and [[Proton pump inhibitor|proton pump inhibitors]] use, worsening [[constipation]])'''
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
** 2.2 '''Vitamin D supplementation'''
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
**:* Preferred regimen (1): [[Calcitriol]] 0.25 to 2 μg q24h (>.75 μg administered in divided doses)
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
**:* Preferred regimen (2): [[Cholecalciferol]] (parent vitamin D3)
===Disease Name===
**:* Preferred regimen (3): [[Ergocalciferol]] (parent vitamin D2)
 
**:* Alternative regimen (1): 1α-Hydroxyvitamin D ([[alfacalcidol]]) '''(used outside the United States)'''
* '''1 Stage 1 - Name of stage'''
**:* Alternative regimen (2): [[Dihydrotachysterol]] '''(used outside the United States)'''
** 1.1 '''Specific Organ system involved 1'''
**:: '''Note(1):''' Serum [[calcium]] ([[Hypoparathyroidism laboratory findings|corrected for albumin]]), [[phosphorus]], and [[creatinine]] concentrations should be measured weekly to monthly during dose adjustments, and twice annually once a stable regimen has been reached.
*** 1.1.1 '''Adult'''
**:: '''Note(2):''' 24 Hour [[urinary]] [[calcium]] and [[creatinine]] should be considered during dose adjustments and should be measured twice annually on a stable regimen to evaluate for [[renal]] toxicity.
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)'''  
* 3 '''Adjunctive Treatments'''
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
** 3.1 '''Diuretics'''
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
*** 3.1.1 '''Thiazides'''
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
****Preferred regimen (1): [[Hydrochlorothiazide]] 25–50 mg q12h (minimum 25 mg to maximum 100 mg)
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
****Alternative regimen (1): [[Chlorthalidone]]
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
***:'''Note(1):''' [[Thiazide diuretics]] are not advised in congenital hypoparathyroidism due to [[autoimmune polyendocrine syndrome type 1]] in patients who have concurrent [[Addison's disease]] or in [[autosomal dominant hypocalcemia]].
*** 1.1.2 '''Pediatric'''
*** 3.1.2 '''Potassium sparing diuretics'''
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
****Alternative regimen (1): [[Amiloride]] 2.5 to 5 mg q12h
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
** 3.2 '''Treatment of hyperphoshatemia'''
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
**:*Preferred regimen (1): Low phosphate diet
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
**:*Preferred regimen (2): [[Phosphate binders]]
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
** 3.3 '''PTH replacement'''
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
**:*Preferred regimen (1): Natpara (rhPTH) 50 μg SC q24h '''(concomitantly decrease the dose of active vitamin D by 50%)'''
****1.1.2.2 (Specific population e.g. ''''''children < 8 years of age'''''')
**:: '''Note(1):''' Monitor serum [[calcium]] and [[albumin]] concentrations every 3–7 days after initiation of therapy and after each dose change.
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 2.1 '''Specific Organ system involved 2'''
*** 2.1.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 2.1.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
 
* 2 '''Stage 2 - Name of stage'''
** 2.1 '''Specific Organ system involved 1 '''
**: '''Note (1):'''  
**: '''Note (2)''':
**: '''Note (3):'''  
*** 2.1.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) ''''''(Contraindications/specific instructions)''''''
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''  
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)


==References==
==References==
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[[Category:Disease]]
[[Category:Medicine]]
[[Category:Endocrinology]]
[[Category:Parathyroid disorders]]
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Latest revision as of 22:18, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2]

Overview

Pharmacologic medical therapies for hypoparathyroidism include calcium and Vitamin D3 supplementation. Severe hypocalcemia, a potentially life-threatening condition, is treated as soon as possible with intravenous calcium (e.g. as calcium gluconate). Generally, a central venous catheter is recommended, as the calcium can irritate peripheral veins and cause phlebitis. Natpara (rhPTH) is a synthetic recombinant human parathyroid hormone approved by U.S. FDA in 2015 for treatment of hypoparathyroidism.

Medical Therapy

Hypoparathyroidism

Management guidelines for hypoparathyroidism are as follows:

References

  1. ↑ Bilezikian JP, Brandi ML, Cusano NE, Mannstadt M, Rejnmark L, Rizzoli R, Rubin MR, Winer KK, Liberman UA, Potts JT (2016). "Management of Hypoparathyroidism: Present and Future". J. Clin. Endocrinol. Metab. 101 (6): 2313–24. doi:10.1210/jc.2015-3910. PMC 5393596. PMID 26938200.

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