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Teriparatide administration by the Omnipod pump: preliminary experience from two cases with refractory hypoparathyroidism

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Abstract

Context

Hypoparathyroidism (hypoPTH) in adults is mainly due to total thyroidectomy. Conventional therapies (calcium, active vitamin D) can fail to normalize calcemia, expose the patient to hypercalciuria and impact quality-of-life. Human parathormone (PTH) replacement therapy is a suitable option in these cases, although few clinical reports have been published so far.

Methods

We describe two cases of patients with refractory postsurgical hypoPTH, in whom subcutaneous infusion of recombinant PTH (teriparatide) through the Omnipod® pump was initiated after failure of all other therapeutic options. Besides, we performed a review of literature of hypoPTH cases treated by continuous infusion of teriparatide.

Results

Two women aged 46 and 61 years old failed to normalize calcemia either with conventional treatments (calcium 8 g/day + calcitriol 9 mcg/day and calcium 5 g/day + calcitriol 12 mcg/day) or with thrice daily subcutaneous injections of teriparatide. As a last resort, teriparatide infusion via Omnipod® device normalized their calcemia and allowed calcium/vitamin D withdrawal, with average teriparatide dose of 23 and 32 mcg/day, respectively. The flow of teriparatide was adapted according to a protocol based on measured calcemia, under medical supervision. In the literature, 15 adult cases (13 women, mean age 44.5 ± 5.2 years old) are reported. HypoPTH was consecutive to surgery in all of them. Mean dose of teriparatide administered was 25 ± 6 mcg/day with improvement of calcemia level and quality-of-life in all patients.

Conclusions

Continuous administration of teriparatide through Omnipod® appears as an efficient therapeutic option in refractory hypoPTH, whose administration to the patient can be assisted by medically-supervised protocol.

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Authors and Affiliations

  1. Assistance-Publique des Hôpitaux de Marseille (AP-HM), Department of Pediatrics, Hôpital de la Timone Enfants, Marseille, France

    Karine Aouchiche & Rachel Reynaud

  2. Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Marseille, France

    Rachel Reynaud, Vincent Amodru, Thierry Brue & Thomas Cuny

  3. Assistance-Publique des Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Marseille, France

    Vincent Amodru, Thierry Brue & Thomas Cuny

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  1. Karine Aouchiche
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Contributions

Conceptualization: K.A. and T.C.; validation: R.R. and T.B.; writing—original draft preparation: K.A. and T.C.; writing—review and editing: R.R., V.A., and T.B.; supervision: R.R. and T.B. All authors have read and agreed to the published version of the manuscript.

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Correspondence to Thomas Cuny.

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The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Institutional Review Board of Aix-Marseille Université (01/01/2021).

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Aouchiche, K., Reynaud, R., Amodru, V. et al. Teriparatide administration by the Omnipod pump: preliminary experience from two cases with refractory hypoparathyroidism. Endocrine 76, 179–188 (2022). https://doi.org/10.1007/s12020-021-02978-6

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