Dear All
For many patients who become hypoparathyroid replacement with calcium and vitamin D analogs is sufficient to restore biochemical and clinical well being. However a significant percentage of patients find that this treatment does not result in good biochemical control of their calcium and in fact many become hypercalciuric
and at risk of forming renal stones when they are still hypocalcaemic and suffering symptoms related to low plasma calcium. This is mainly due to the lack of PTH and its effect on calcium reabsorption via the kidneys. Many of these patients feel very unwell and although they are often able to tell when they are hypocalcaemic they are often unable to distinguish the symptoms of hypercalcaemia and can have high calcium and yet feel the desire to take even more calcium supplement to try and overcome the vague symptoms they are suffering. The recent availability of PTH as PTH (1-34)(Lilly Forsteo) or PTH (1-84) (Nycomed Preotact) has resulted in several endocrinologists resorting to using these agents (off licence) in difficult cases. The Di George patients often have greater fluctuations in their calcium and more symptoms than iatrogenic hypoparathyroid patients and so some of them have been treated with PTH by injection. It therefore becomes possible to titrate calcium much more carefully with combinations of calcium/vitamin D and its analogs/PTH treatment and I have conducted the first major randomised controlled study sponsored by NPS (using PTH (1-84)) in these patients. The questions raised by the patients/relatives regarding the ability to control and refine their treatment to optimise calcium response will no doubt increase with the refinement and future availability of these treatments.
Regards
Professor William D Fraser
Professor of Medicine
Norwich Medical School
Faculty of Health
University of East Anglia
Norwich
NR4 7TJ
e-mail [log in to unmask]
Phone
Fax 01603 593752
________________________________________
From: Clinical biochemistry discussion list [[log in to unmask]] on behalf of Steiner, Michael [[log in to unmask]]
Sent: 19 July 2011 10:44
To: [log in to unmask]
Subject: Calcium/hypoPT
Jonathan's question was:
How variable is calcium in this condition once you are on treatment?
Probably not very variable.
Modified question:
How variable is calcium in this condition once you are on treatment PLUS CALCIUM/VITAMIN D OVER THE COUNTER (OTC) ?
Unpredictable, risk of severe hypercalcaemia/acute renal failure unknown.
Mike
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