Fracaso de la hormona sintética paratiroidea (teriparatida) en el tratamiento del hipoparatiroidismo postquirúrgico / Therapeutic failure of synthetic parathyroid hormone (teriparatide) in treatment of postsurgical hypoparathyroidism

RESUMEN

Se presenta un paciente con enfermedad renal cronica e hipoparatiroidismo postquirurgico tratado con calcitriol y carbonato calcico, a quien se le practico trasplante renal. Meses mas tarde revela hipocalcemia severa con hiperfosfatemia refractaria a altas dosis de calcitriol y carbonato calcico, optandose por utilizar teriparatida un fragmento aminoterminal (1-34) sintetico de la paratohormona, con mejoria transitoria. Luego desarrolla resistencia a la misma a pesar de su utilizacion a dosis no convencionales (120 ¦Ìg/dia), siendo necesaria su suspension y el uso de nuevo de dosis muy altas de calcitriol y carbonato calcico para lograr estabilizacion. La hiperfosfatemia desencadenada fue manejada posteriormente con quelantes de fosfatos via oral...

ABSTRACT

It is presented a male patient with chronic renal failure and postsurgical hypoparathyroidism treated with calcitriol and calcium carbonate in which renal transplant was practiced. Months later, he had severe hipocalcemia and hyperphosphatemia refracting to high doses of calcitriol and calcium carbonate, opting to use of teriparatide, an aminoterminal fragment (1-34) synthetic of parathyroid hormone, with transient improvement. Then, the patientdeveloped resistance to teriparatide despite its use to nonconventional dose (120 ¦Ìg/day), making necessary its suspension and re-use high doses of calcitriol and calcium carbonate to achieve stabilization. Hyperphosphatemia was treated subsequently with oral phosphate binders...