Impact of the cholecalciferol calcitriol coadministration on the metabolic control, calciuria and renal function in patients with hypoparathyroidism

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 234-256-Bone & Calcium Metabolism: Clinical Trials & Case Series
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-247
Leticia Iervolino*1, Nilza Maria Scalissi2 and Sergio Setsuo Maeda2
1Irmandade da Santa Casa de Misericórdia de São Paulo, Brazil, São Paulo, Brazil, 2Irmandade da Santa Casa de Misericórdia de São Paulo, Brazil
Introduction: Hypoparathyroidism is a rare disease, resulting from the insufficient action or secretion of PTH, generating reduced calcemia and increased phosphate levels. The classical treatment is the administration of calcium and vitamin D. The objective of the treatment is maintaining normal calcemia, avoiding hypercalciuria, which would predispose to nephrolithiasis and nephrocalcinosis. The use of cholecalciferol associated with calcitriol can aid in the calcemia maintenance, without increasing the risk for hypercalciuria and renal function. Our aim is to evaluate the impact of the cholecalciferol calcitriol combined therapy on calcemia, phosphatemia and renal function. Cases: Nineteen hypoparathyroidism patients were analyzed, according to the following distribution: 15 presented post-surgical hypoparathyroidism and four other etiology, all followed as outpatients at our Endocrinology ambulatory. The sample was composed of 15 women and four men. Mean age of the group was 55±21.2 years old and the mean age at diagnosis was 44.6±20.6 years old. The average follow up time was 10.5±8 years. Methods: A retrospective analysis of patient records from a university hospital was performed. For statistical analysis the Student´s t-test was used to compare calcemia levels (Reference: 8.8-10.3 mg/dL), calciuria (Reference:  1-4 mg/kg/d) and creatinine (Reference: 0.6-1.3mg/dL), all pre- and post-medication adjustment. The Mann-Whitney test was used to compare phosphate values (Reference: 2.5-4.5 mg/dL). Results: In the sample evaluated, 21% used cholecalciferol at the average dose of 107.850±118.000U/week and 52% of the patients were using calcitriol (average dose: 0.82±0.62microgram/day). A combined therapy using cholecalciferol was initiated for 100% of the patients with doses ranging from 4.000 to 140.000 units/week (average dose: 34,071±40,000 U/week). After association, 63% of the patients were using calcitriol in doses between 0.25 to 1.5 micrograms/day (average dose: 0.56±0.37micrograms/day). Before adjustment, 89% were using calcium supplements, with doses of 788±613mg/day and after adjustment 655±255mg/day. The average pre-adjustment calcemia was 6.8±0.7 mg/dL, while during follow up it was 8.3±0.7 mg/dL (p<0.001). The pre-treatment phosphate median was 5.5 mg/dL (variation: 3.3-10.0) while in the post-follow up it was 4.6 mg/dL (variation: 1.9-5.3) (p=0.016). The pre-adjustment calciuria was 0.7±0.7 mg/kg/d while the post-adjustment was 2.5±2.5 mg/kg/d (p=0.146). The pre-adjustment creatinine was 0.85±0.2 mg/dL while the post-adjustment one was 0.9±0.2 mg/dL (p=0.835). Conclusions: By the cholecalciferol calcitriol combined administration it was possible to increase calcemia without promoting significant increase in calciuria and serum creatine. It was possible to use even smaller doses of cholecalciferol, calcitriol and calcium.

(1)Bilezikian, JP, et al. Hipoparathyroidism in the Adult: Epidemiology, Diagnosis, Pathophysiology, Target- Organ Involvement, Treatment, and Challenges for Future Research. JBMR. 26(10): 2317- 2337, 2011; (2) Maeda SS, et al. Hypoparathyroidism and Pseudohypoparathyroidismm.Arq Bras Endocrinol Metab. 50(4): 664- 673, 2006; (3)Khan, MI; Waguespack SG; Hu MI. Medical Management of Postsurgical Hypoparathyroidism. Endocr Pract. 17(1): 18- 25, 2011;(4)Schäffler, A. Hormone Replacement After Thyroid and Parathyroid Surgery. Deutsches Ärzteblatt International | Dtsch Arztebl Int. 107(47): 827–34, 2010;(5) Winer, KK. Long-Term Treatment of Hypoparathyroidism: A Randomized Controlled Study Comparing Parathyroid Hormone-(1–34) Versus Calcitriol and Calcium. J Clin  Endocrinol Metab. 88(9):4214–4220, 2003

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