Endocrine Abstracts

Hypoparathyroidism is a rare disease that is mostly caused by inadvertent surgical removal of parathyroid glands. Historically, management of hypoparathyroidism has been by a ’workaround’ utilising initially very high doses of native vitamin D and in more recent times, combinations of active vitamin D, sometimes with calcium supplementation (and thiazide diuretics). To date, there is no universally available hormone replacement therapy for this hormone deficiency state. Some of the long-term complications of hypoparathyroidism are mediated or exacerbated by the standard of care approaches. In particular, renal dysfunction in association with hypercalciuria is a frequent longer-term complication. Furthermore, from a patient experience perspective, many patients experience life-changing neurocognitive symptoms that cannot be addressed by simply normalising calcium homeostasis. The emergence of PTH replacement therapies that mimic physiology have allowed a more desirable approach to long-term management of hypoparathyroidism. Care for patients with hypoparathyroidism is variable, as highlighted in national GIRFT reports. On the backdrop of above, the European Society for Endocrinology have recently updated guidance on management of chronic hypoparathyroidism and propose a position for PTH replacement therapy, particularly in those cases that are not adequately controlled on conventional therapy. This talk will review those guidelines that are timely as later this year, we will learn from NICE the national position of the first new PTH replacement therapy.