AACE MENA 2025-Diagnosis and Management of Hypoparathyroidism

Video Transcription

Video Summary

This detailed presentation on hypoparathyroidism covers diagnosis, management, complications, and recent advances in treatment. Hypoparathyroidism causes low parathyroid hormone (PTH), leading to hypocalcemia, hyperphosphatemia, and hypercalciuria. Major complications include kidney issues (nephrocalcinosis, nephrolithiasis, chronic kidney disease), ectopic calcifications (e.g., basal ganglia), seizures, cognitive impairment, cardiac arrhythmias, psychiatric symptoms, and increased mortality. Conventional therapy with calcium and active vitamin D normalizes serum calcium but worsens hypercalciuria and phosphate levels, increasing renal and vascular risks.<br /><br />New approaches focus on PTH replacement. Extended half-life PTH analog palopegteriparatide (PTH 1-34 PEGylated) provides steady physiological levels for 24 hours, enabling most patients to discontinue conventional therapy, reduce urine calcium, stabilize bone remodeling and density, improve renal function (even reversing chronic kidney disease stages), and enhance quality of life with minimal side effects. Dosing adjustments are made weekly due to the drug’s long half-life.<br /><br />Other novel therapies include calcilytic agents targeting activating calcium-sensing receptor mutations and long-acting PTHrP analogs providing prolonged receptor activation. These advances promise more targeted treatments, potentially reducing morbidity and mortality. Current recommendations emphasize careful evaluation, conventional therapy initiation, and transition to PTH replacement in poorly controlled cases to optimize outcomes.

Keywords

hypoparathyroidism

parathyroid hormone replacement

palopegteriparatide

hypocalcemia

nephrocalcinosis

calcilytic agents

bone remodeling