La gestione terapeutica dell’ipoparatiroidismo: tra terapia convenzionale e nuove prospettive

Hypoparathyroidism is a rare endocrine disorder characterised by hypocalcaemia, hyperphosphataemia, and inappropriate levels of parathyroid hormone (PTH). In most cases, it results from damage to the parathyroid glands occurring during thyroidectomy or parathyroidectomy surgeries (75% of cases). Conventional therapy does not include the replacement treatment with PTH, but relies on oral supplementation with calcium and active vitamin D. However, a subset of patients does not achieve adequate biochemical control, experiencing persistent symptoms, complications, and complaining about reduced quality of life. In recent years, hypoparathyroidism management has shifted toward innovative therapies. Replacement therapies with PTH or drugs that mimic its action have been proposed. PTH therapy has faced challenges due to its short half-life, necessitating multiple daily injections or continuous subcutaneous infusion via a pump. Recent advances in the understanding of the disease’s pathophysiology have paved the way for new therapeutic approaches, including long-acting PTH formulations, PTH receptor analogues, and, more recently, calcilytic agents. These emerging therapies are currently under clinical investigation, showing promising results. However, their future application will depend on further studies of their efficacy and the long-term impacts on bone metabolism and kidney function, which remain to be fully determined.