Sections

Medication

Isotonic crystalloids

Class Summary

Sodium chloride 0.9% fluid is used to supply intravenous hydration to replace fluids lost by emesis for patients with acute hypercalcemia of any etiology.

Class Summary

Bisphosphonates are antiresorptive agents that are used to help preserve bone mass. They are available in oral and parenteral forms. The inhibition of bone resorption produces a hypocalcemic effect. These agents are used in the management of conditions associated with increased bone resorption (eg, osteoporosis, Paget disease, management of hypercalcemia [especially that associated with malignancy]).

In case of acute hypercalcemia with vomiting, parenteral therapy is recommended. By reducing bone resorption, a calcium-lowering effect in the blood may occur.

Pamidronate (Aredia)

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IV bisphosphonate that acts as an antiresorptive agent. Inhibits normal and abnormal bone resorption. Appears to inhibit bone resorption without inhibiting bone formation and mineralization. Currently accepted uses include the treatment of hypercalcemia associated with neoplasms and metastases as well as for treatment of Paget disease. This category of drugs is not approved for the treatment of hypercalcemia secondary to hyperparathyroidism; however, in practice, can be used for this as well as in the management of postmenopausal osteoporosis. Now being used in pediatrics to treat osteogenesis imperfecta and idiopathic juvenile osteoporosis. Preliminary study results on its use to prevent bone loss following severe burns appear promising.

Zoledronate

Class Summary

These agents are allosteric modulators of the CASR and thus reduce PTH levels

Cinacalcet (Sensipar)

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Directly lowers intact parathyroid hormone (iPTH) levels by increasing sensitivity of calcium sensing receptor on chief cell of parathyroid gland to extracellular calcium. Also results in concomitant serum calcium decrease. Indicated for secondary hyperparathyroidism in patients with chronic kidney disease on dialysis.

Calcitriol

Calcitriol is used for post -surgical hypoparathyroidism in conjunction with calcium supplements.

Follow-up

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Available at http://www.fda.gov/Drugs/DrugSafety/ucm340551.html.
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Media Gallery

Normal parathyroid glands as seen during a thyroidectomy. The large arrow points to the superior parathyroid. The thinner arrow points to the inferior parathyroid. The forceps points toward the recurrent laryngeal nerve. The patient's head is toward the right.

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Table 1. Causes of hyperparathyroidism

Table 1. Causes of hyperparathyroidism

Cause	Gene	OMIM
1. Neonate/Infant
Primary
- Familial hypocalciuric hypercalcemia	Heterozygous inactivating CASR mutations	145980
- Neonatal severe hyperparathyroidism	Homozygous inactivating CASR mutations	239200
Secondary
- Maternal hypoparathyroidism
- Maternal pseudohypoparathyroidism
- Maternal Vitamin D deficiency

2. Child/adolescent
Primary
- Sporadic adenomas
- Familial
* Familial hypocalciuric hypercalcemia (FHH)	CASR	145980
* Multiple Endocrine Neoplasia type 1 (MEN1)	MEN1	131100
* Multiple Endocrine Neoplasia type 2a	RET	171400
* Multiple Endocrine Neoplasia type 4	CDKN1B	610755
* Familial hyperparathyroidism jaw tumor syndrome (HRPT2)	CDC73	145001

- Autoantibodies to the CASR
Secondary
- Renal failure/post renal transplant
- Chronic hyperphosphatemia
- Vitamin D deficiency
* Nutritional
* Malabsorption
-Vitamin D dependent rickets type 1 VDDR1	CYP27B1	264700

- Vitamin D dependent rickets type 2 VDDR2	Vitamin D receptor	277440

-Other causes of hypocalcemia
Poor intake Drugs

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Author

Edna E Mancilla, MD Associate Professor of Clinical Pediatrics, Perelman School of Medicine at the University of Pennsylvania; Attending Physician in Pediatric Endocrinology, The Children's Hospital of Philadelphia

Edna E Mancilla, MD is a member of the following medical societies: American Society for Bone and Mineral Research, Chilean Society of Endocrinology and Diabetes, Chilean Society of Osteology and Mineral Metabolism, Endocrine Society, Latin American Society of Pediatric Endocrinology, Pediatric Endocrine Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: IPSEN Biopharmaceuticals Inc<br/>Research support for: Clementia/Ipsen pharmaceuticals.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London) Professor and Chair, First Department of Pediatrics, Athens University Medical School, Aghia Sophia Children's Hospital, Greece; UNESCO Chair on Adolescent Health Care, University of Athens, Greece

George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London) is a member of the following medical societies: American Academy of Pediatrics, American College of Physicians, American Pediatric Society, American Society for Clinical Investigation, Association of American Physicians, Endocrine Society, Pediatric Endocrine Society, Society for Pediatric Research, American College of Endocrinology

Disclosure: Nothing to disclose.

Chief Editor

Sasigarn A Bowden, MD Associate Professor of Pediatrics, Section of Pediatric Endocrinology, Metabolism and Diabetes, Department of Pediatrics, Ohio State University College of Medicine; Pediatric Endocrinologist, Associate Fellowship Program Director, Division of Endocrinology, Nationwide Children’s Hospital; Affiliate Faculty/Principal Investigator, Center for Clinical Translational Research, Research Institute at Nationwide Children’s Hospital

Sasigarn A Bowden, MD is a member of the following medical societies: American Society for Bone and Mineral Research, Central Ohio Pediatric Society, Endocrine Society, International Society for Pediatric and Adolescent Diabetes, Pediatric Endocrine Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

Gordon L Klein, MD, MPH Clinical Professor of Orthopedic Surgery and Rehabilitation, University of Texas Medical Branch School of Medicine

Gordon L Klein, MD, MPH is a member of the following medical societies: American Academy of Pediatrics, American Society for Nutrition, American Gastroenterological Association, American Pediatric Society, American Society for Bone and Mineral Research, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Society for Pediatric Research

Disclosure: Nothing to disclose.

Phyllis W Speiser, MD Chief, Division of Pediatric Endocrinology, Steven and Alexandra Cohen Children's Medical Center of New York; Professor of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell

Phyllis W Speiser, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, Endocrine Society, Pediatric Endocrine Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Pediatric Hyperparathyroidism Medication

Isotonic crystalloids

Class Summary

Bisphosphonates

Class Summary

Pamidronate (Aredia)

Pamidronate (Aredia)

Zoledronate

Calcimimetic Agent

Class Summary

Cinacalcet (Sensipar)

Cinacalcet (Sensipar)

1,25 OH2 Vitamin D

Calcitriol

Pediatric Hyperparathyroidism Medication

Isotonic crystalloids

Class Summary

Bisphosphonates

Class Summary

Pamidronate (Aredia)

Pamidronate (Aredia)

Zoledronate

Calcimimetic Agent

Class Summary

Cinacalcet (Sensipar)

Cinacalcet (Sensipar)

1,25 OH2 Vitamin D

Calcitriol

References

Tables

Contributor Information and Disclosures

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