Hypoparathyreoidismus

Zusammenfassung

Hypoparathyreoidismus und Lebensqualität: Der Hypoparathyreoidismus (HPT) geht auch bei ausreichend substituierten Patienten mit einer verminderten Lebensqualität einher. Ein möglicher Zusammenhang zwischen reduzierter Lebensqualität und fehlender zentralnervöser Wirkung des Parathomons (PTH) bei Patienten mit einem HPT wird vermutet. Ein positiver Effekt auf die Lebensqualität konnte unter Therapie mit PTH beobachtet werden.

Hypoparathyreoidismus und Komorbiditäten: Assoziierte Komorbiditäten umfassen insbesondere ein erhöhtes Risiko für Nephrolithiasis/Nephrokalzinose und neuro-psychiatrische Erkrankungen. Auch ein erhöhtes kardiovaskuläres Risikoprofil sowie eine vermehrte Infektneigung wurden beobachtet. Die Mortalität erscheint beim HPT nicht erhöht.

Hypoparathyreoidismus und neue Therapiekonzepte: Noch ist rekombinantes PTH in Europa nicht für die Therapie des HPT zugelassen. Anfang des Jahres erfolgte in den USA jedoch bereits die Zulassung von PTH (1–84) durch die FDA. Die tägliche subkutane Gabe von PTH (1–84) sowie von Teriparatid (PTH (1–34)) hat sich in kleinen Studien bereits in den vergangenen Jahren als erfolgversprechende Therapieoption gezeigt. Es sollte allerdings Patienten vorbehalten sein, die mit der Standardtherapie aus aktivem Vitamin D Hormon (und Kalzium) unzureichend therapiert sind.

Abstract

Hypoparathyroidism and quality of life: Even in adequately substituted patients, hypoparathyroidism (HPT) is associated with impaired quality of life. It has been hypothesized that there is a correlation between reduced quality of life and lack of parathyroid hormone (PTH) in the central nervous system. Positive effects on quality of life have been reported when treating HPT with PTH.

Hypoparathyroidism and comorbidities: Comorbidities associated with HPT include an increased risk of nephrolithiasis/nephrocalcinosis and neuro-psychiatric disease. Additionally, cardiovascular risk profile and an increased susceptibility for infections have been reported. Mortality rates seem not to be increased in HPT.

Hypoparathyroidism and new therapeutic strategies: Recombinant PTH has not been approved for the treatment of HPT in Europe yet. However, in early 2015, the FDA approved PTH (1–84). Daily subcutaneous delivery of PTH (1–84) and PTH (1–34) (Teriparatide) has emerged as a promising therapeutic tool. However, its use should be restricted to patients insufficiently controlled with the standard treatment consisting of active vitamin d and calcium.

Schlüsselwörter

Hypoparathyreoidismus - Lebensqualität - Komorbiditäten - Therapie - Parathormon

Keywords

hypoparathyroidism - quality of life - comorbidities - treatment - PTH

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