Endocrine Abstracts

The spectrum of symptoms associated with hypoparathyroidism span from virtually none to severely debilitating fatigue, memory loss, muscle cramps, and paresthesia. Until recently disease management has focused on securing stable serum calcium values at the lower end of the reference range using potent active vitamin D analogues like Etalpha and Rocaltrol, together with calcium supplementation. Recently maintenance of adequate levels of 25(OH)D have also been mentioned as being important. Adequate intracellular magnesium levels seem to be pivotal for PTH secretion and action at the receptor level, and should therefore be kept at the upper end of the normal range if possible. It is one few endocrine diseases where supplementation of missing hormone was impossible about 10 years ago. Now we have access to recombinant PTH(1-34) and PTH(1-84), and I will review the potential use of and differences between these analogues in the treatment of hypoparathyroidism. In terms of symptomatic relief the results of controlled studies using these analogues as sc. injections have been disappointing. A more physiological pattern can be achieved with continuous subcutaneous infusion using insulin pumps, and I will review the results obtained with this technique so far.