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


METHODS
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.


METHODS
Tertiary care center.


METHODS
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.


METHODS
A dose of PTH 1-34 was administered each morning by subcutaneous injection. Calcitriol was given orally twice daily with supplemental calcium carbonate.


METHODS
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.
Winer
K K
KK
Developmental Endocrinology Branch of the National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-1862, USA.
Yanovski
J A
JA
Cutler
G B
GB
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood / Q000652:urine; D002117:Calcitriol / Q000008:administration & dosage / Q000627:therapeutic use*; D002118:Calcium / Q000097:blood / Q000378:metabolism* / Q000652:urine; D002119:Calcium Carbonate / Q000008:administration & dosage / Q000627:therapeutic use; D002908:Chronic Disease; D018592:Cross-Over Studies; D000242:Cyclic AMP / Q000652:urine; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007011:Hypoparathyroidism / Q000097:blood / Q000188:drug therapy* / Q000652:urine; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010446:Peptide Fragments / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010758:Phosphorus / Q000097:blood / Q000652:urine; D011994:Recombinant Proteins / Q000627:therapeutic use; D019379:Teriparatide
D015415:Biomarkers; D010281:Parathyroid Hormone; D010446:Peptide Fragments; D011994:Recombinant Proteins; D019379:Teriparatide; D010758:Phosphorus; D000242:Cyclic AMP; D002117:Calcitriol; D002119:Calcium Carbonate; D002118:Calcium