Initiation of Continuous rhPTH Infusion With Insulin Pump in an Inpatient Setting

Faith Lindsay Mart; Karen K Winer; Karla Johnson; Halley Wasserman

doi:10.1210/jcemcr/luad136

Initiation of Continuous rhPTH Infusion With Insulin Pump in an Inpatient Setting

JCEM Case Rep. 2023 Nov 7;1(6):luad136. doi: 10.1210/jcemcr/luad136. eCollection 2023 Nov.

Authors

Faith Lindsay Mart¹, Karen K Winer², Karla Johnson¹, Halley Wasserman^{1

3}

Affiliations

¹ Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
² National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA.
³ Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA.

Abstract

Hypoparathyroidism is one of the few remaining hormonal insufficiencies not treated with replacement of its missing hormone. Conventional therapy involves multiple daily oral doses of calcium, active vitamin D, and magnesium, which is not only cumbersome for patients, but carries risk of nephrocalcinosis and is inadequate in patients with enteral malabsorption. Subcutaneous parathyroid hormone 1-34 (PTH[1-34]) has been tested as a hormonal replacement therapy for treatment of hypoparathyroidism. PTH(1-34) delivered by continuous infusion via insulin pump decreases or eliminates the need for oral medications, stabilizes serum and urine calcium at normal levels with minimal fluctuation, and significantly reduces PTH doses. In this case report, we describe the clinical application of PTH(1-34) via insulin pump in an adolescent with autoimmune polyendocrinopathy syndrome type 1 (APS1). Transition to a PTH pump reduced hospital admissions for calcium abnormalities and allowed our patient to discontinue all scheduled daily conventional therapy.

Keywords: autoimmune polyendocrinopathy syndrome type 1; autoimmune polyglandular syndrome type 1; continuous PTH delivered by pump; hypoparathyroidism; recombinant human parathyroid hormone.

Publication types

Case Reports