Evidence-Based Hormone Therapies

Parathormone

Parathormone’s major role is to maintain constant calcium levels in the blood. As soon as the calcium level decreases in the serum, the level of parathormone increases in the serum to correct the situation. When the serum calcium level increases, the level of parathormone decreases to permit the calcium level to gradually lower and normalize.

By keeping the calcium levels constant in the blood, parathormone exerts two major roles:

  1. It keeps nerves and muscles (including cardiac muscle) relaxed and well-functioning. When calcium levels are too low, muscles tense and go into spasmic contractions that may ultimately lead to titanic contractions and death in extreme cases – such as surgical removal of all four parathyroid glands at the occasion of a total removal of the thyroid gland (thyroidectomy) for thyroid cancer.
  2. It helps prevent or reverse osteoporosis. By elevating the calcium level in the blood, parathormone makes more calcium available for the bones. Parathormone increases the serum level of calcium by stimulating calcium absorption in the intestine from food if the diet is rich enough in absorbable calcium and vitamin D levels are sufficient to help absorb the calcium. However, with a diet poor in calcium or when the levels of vitamin D are low, parathormone causes unwanted bone density loss by increasing serum calcium levels through extraction from the bones.
Higher quality of life: the association with higher parathormone levels (3 references)
  1. Arneiro AJ, Duarte BCC, Kulchetscki RM, Cury VBS, Lopes MP, Kliemann BS, Bini IB, Assad M, Biagini GLK, Borba VZC, Moreira CA. Self-report of psychological symptoms in hypoparathyroidism patients on conventional therapy. Arch Endocrinol Metab. 2018 Jun;62(3):319-324.
  2. Vokes TJ, Mannstadt M, Levine MA, Clarke BL, Lakatos P, Chen K, Piccolo R, Krasner A, Shoback DM, Bilezikian JP. Recombinant human parathyroid hormone effect on health-related quality of life in adults with chronic hypoparathyroidism. J Clin Endocrinol Metab. 2018 Feb 1;103(2):722-731.
  3. Shoback DM, Bilezikian JP, Costa AG, Dempster D, Dralle H, Khan AA, Peacock M, Raffaelli M, Silva BC, Thakker RV, Vokes T, Bouillon R. Presentation of hypoparathyroidism: etiologies and clinical features. J Clin Endocrinol Metab.2016 Jun;101(6):2300-12.
Lower quality of life: the improvement with parathormone treatment (21 references)
  1. Napoli N, Langdahl BL, Ljunggren Ö, Lespessailles E, Kapetanos G, Kocjan T, Nikolic T, Eiken P, Petto H, Moll T, Lindh E, Marin F. Effects of teriparatide in patients with osteoporosis in clinical practice: 42-month results during and after discontinuation of treatment from the european extended forsteo® observational study (exfos). Calcif Tissue Int. 2018 Jun 16.
  2. Langdahl BL, Rajzbaum G, Jakob F, Karras D, Ljunggren O, Lems WF, Fahrleitner-Pammer A, Walsh JB, Barker C, Kutahov A, Marin F. Reduction in fracture rate and back pain and increased quality of life in postmenopausal women treated with teriparatide: 18-month data from the European Forsteo Observational Study (EFOS). Calcif Tissue Int. 2009 Dec;85(6):484-93
  3. Vokes TJ, Mannstadt M, Levine MA, Clarke BL, Lakatos P, Chen K, Piccolo R, Krasner A, Shoback DM, Bilezikian JP. Recombinant human parathyroid hormone effect on health-related quality of life in adults with chronic hypoparathyroidism. J Clin Endocrinol Metab. 2018 Feb 1;103(2):722-731.
  4. Upreti V, Somani S, Kotwal N. Efficacy of teriparatide in patients with hypoparathyroidism: a prospective, open-label study. Indian J Endocrinol Metab. 2017 May-Jun;21(3):415-418.
  5. Caggiari G, Leali PT, Mosele GR, Puddu L, Badessi F, Doria C. Safety and effectiveness of teriparatide vs alendronate in postmenopausal osteoporosis: a prospective non randomized clinical study. Clin Cases Miner Bone Metab. 2016 Sep-Dec;13(3):200-203.

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High mood, low risk of depression: the association with higher parathormone levels (2 references)
  1. Arneiro AJ, Duarte BCC, Kulchetscki RM, Cury VBS, Lopes MP, Kliemann BS, Bini IB, Assad M, Biagini GLK, Borba VZC, Moreira CA. Self-report of psychological symptoms in hypoparathyroidism patients on conventional therapy. Arch Endocrinol Metab. 2018 Jun;62(3):319-324.
  2. Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L. Postsurgical hypoparathyroidism-risk of fractures, psychiatric diseases, cancer, cataract, and infections. J Bone Miner Res. 2014 Nov;29(11):2504-10.
Sarcopenia: the association with excessive parathormone levels (1 reference)
  1. Visser M, Deeg DJ, Lips P; Longitudinal Aging Study Amsterdam. Low vitamin D and high parathyroid hormone levels as determinants of loss of muscle strength and muscle mass (sarcopenia): the Longitudinal Aging Study Amsterdam. J Clin Endocrinol Metab. 2003 Dec;88(12):5766-72
Obesity, higher fat mass: the association with excessive parathormone levels (1 reference)
  1. Rejnmark L, Vestergaard P, Brot C, Mosekilde L. Parathyroid response to vitamin D insufficiency: relations to bone, body composition and to lifestyle characteristics. Clin Endocrinol (Oxf). 2008 Jul;69(1):29-35
Atherosclerosis (carotid intima media thickness): the association with excessive parathormone levels (4 references)
  1. Asghari G, Mirmiran P, Yuzbashian E, Dehghan P, Mahdavi M, Tohidi M, Wagner CL, Neyestani TR, Hosseinpanah F, Azizi F. Association of circulating 25-hydroxyvitamin D and parathyroid hormone with carotid intima media thickness in children and adolescents with excess weight. J Steroid Biochem Mol Biol. 2019 Apr;188:117-123.
  2. Lee YH, Kweon SS, Choi JS, Nam HS, Park KS, Choi SW, Ryu SY, Oh SH, Shin MH. Association of serum vitamin D and parathyroid hormone with subclinical atherosclerotic phenotypes: The Dong-gu Study. PLoS One. 2017 Oct 31;12(10)
  3. Bellasi A, Raggi P, Rossi R, Rochira V, Stentarelli C, Zona S, Lattanzi A, Carli F, Mussini C, Guaraldi G. Intact parathyroid hormone levels are associated with increased carotid intima media thickness in HIV infected patients. Atherosclerosis. 2014 Dec;237(2):618-22.
  4. Choi HS, Kim SH, Rhee Y, Cho MA, Lee EJ, Lim SK. Serum parathyroid hormone is associated with carotid intima-media thickness in postmenopausal women. Int J Clin Pract. 2008 Sep;62(9):1352-7.
Atherosclerosis (carotid intima media thickness): the improvement with parathormone therapy (1 reference)
  1. Yoda M, Imanishi Y, Nagata Y, Ohara M, Yoda K, Yamada S, Mori K, Inaba M. Teriparatide therapy reduces serum phosphate and intima-media thickness at the carotid wall artery in patients with osteoporosis. Calcif Tissue Int. 2015 Jul;97(1):32-9.
Arterial hypertension: the association with excessive parathormone levels (1 reference)
  1. Hjelmesaeth J, Hofsø D, Aasheim ET, Jenssen T, Moan J, Hager H, Røislien J, Bollerslev J. Parathyroid hormone, but not vitamin D, is associated with the metabolic syndrome in morbidly obese women and men: a cross-sectional study. Cardiovasc Diabetol. 2009 Feb 3;8:7
Cardiac dysfunction: the association with excessive parathormone levels (3 references)
  1. Aceña Á, Pello AM, Carda R, Lorenzo Ó, Gonzalez-Casaus ML, Blanco-Colio LM, Martín-Ventura JL, Palfy J, Orejas M, Rábago R, Gonzalez-Parra E, Mahíllo-Fernández I, Farré J, Egido J, Tuñón J. Parathormone levels are independently associated with the presence of left ventricular hypertrophy in patients with coronary artery disease. J Nutr Health Aging. 2016;20(6):659-64.
  2. Zhao CT, Yeung CK, Siu CW, Tam S, Chan J, Chen Y, Chan HH, Tse HF, Yiu KH. Relationship between parathyroid hormone and subclinical myocardial dysfunction in patients with severe psoriasis. J Eur Acad Dermatol Venereol. 2014 Apr;28(4):461-8.
  3. Pilz S, Tomaschitz A, Drechsler C, Ritz E, Boehm BO, Grammer TB, März W. Parathyroid hormone level is associated with mortality and cardiovascular events in patients undergoing coronary angiography. Eur Heart J. 2010 Jul;31(13):1591-8.
Coronary heart disease: the association with excessive parathormone levels (8 references)
  1. Ramos Ruiz P, Jaulent Huertas L, Castañeda Sancirilo M, Martínez Díaz JJ, Clavel Ruipérez G, García de Guadiana Romualdo L, Wasniewski S, Merelo Nicolás M, García Escribano I, Soria Arcos F, Castillo Moreno JA, Consuegra Sánchez L. Parathyroid hormone, calcidiol, calcitriol and adverse events in the acute coronary syndrome. Med Intensiva. 2018 Mar;42(2):73-81.
  2. Wu GY, Xu BD, Wu T, Wang XY, Wang TX, Zhang X, Wang X, Xia Y, Zong GJ. Correlation between serum parathyroid hormone levels and coronary artery calcification in patients without renal failure. Biomed Rep. 2016 Nov;5(5):601-606.
  3. Malluche HH, Blomquist G, Monier-Faugere MC, Cantor TL, Davenport DL. High Parathyroid hormone level and osteoporosis predict progression of coronary artery calcification in patients on dialysis. J Am Soc Nephrol. 2015 Oct;26(10):2534-44.
  4. Zhao FL, Zhang YZ, Tai GX, Wang Y, Tong QH, Fu L. Serum parathyroid hormone as a potential novel biomarker of coronary heart disease. Genet Test Mol Biomarkers. 2014 Oct;18(10):670-4.
  5. Chen WR, Chen YD, Shi Y, Yin DW, Wang H, Sha Y. Vitamin D, parathyroid hormone and risk factors for coronary artery disease in an elderly Chinese population. J Cardiovasc Med (Hagerstown). 2015 Jan;16(1):59-68.

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Coronary heart disease: the improvement with parathormone treatment (1 reference)
  1. Fazekas R, Soós P, Kékesi V, Fazekas L, Juhász-Nagy A. The coronary effects of parathyroid hormone. Horm Res. 2004;61(5):234-41.
Coronary heart disease: the improvement with parathormone treatment (animal study) (1 reference)
  1. Zaruba MM, Huber BC, Brunner S, Deindl E, David R, Fischer R, Assmann G, Herbach N, Grundmann S, Wanke R, Mueller-Hoecker J, Franz WM. Parathyroid hormone treatment after myocardial infarction promotes cardiac repair by enhanced neovascularization and cell survival. Cardiovasc Res. 2008 Mar 1;77(4):722-31.
Cardiac arrhythmias: the association with low parathormone levels (2 references)
  1. Marcucci G, Cianferotti L, Brandi ML. Clinical presentation and management of hypoparathyroidism. Best Pract Res Clin Endocrinol Metab. 2018 Dec;32(6):927-939.
  2. Giusti F, Brandi ML. Clinical Presentation of Hypoparathyroidism. Front Horm Res. 2019;51:139-146.  
Heart failure: the association with low-normal parathormone levels (1 reference)
  1. Sugimoto T, Dohi K, Onishi K, Yamada T, Horiguchi M, Takamura T, Kawamura A, Seko T, Nakamura M, Kasai A, Ito M. Prognostic value of serum parathyroid hormone level in acute decompensated heart failure. Circ J. 2014;78(11):2704-10.
Heart failure: the association with excessive parathormone levels (11 references)
  1. Kubiak GM, Kolaszko A, Nowalany-Kozielska E. Parathyroid hormone serum concentration in Central European patients with non-ischaemic heart failure as a potential marker of disease severity and poor prognosis. Endokrynol Pol. 2017;68(3):299-305.
  2. Bezgin T, Elveran A, Karagoz A, Canga Y, Dogan C. Parathyroid hormone is associated with heart failure with preserved ejection fraction. Bratisl Lek Listy. 2016;117(8):442-7.
  3. Belen E, Tipi FF, Aykan AC, Findikçioğlu U, Karakuş G, Yeşil A, Helvaci A, Kalaycioğlu E, Cetin M. Clinical staging in chronic heart failure associated with low vitamin D and elevated parathormone levels. Acta Cardiol. 2014 Dec;69(6):665-71.
  4. Bansal N, Zelnick L, Robinson-Cohen C, Hoofnagle AN, Ix JH, Lima JA, Shoben AB, Peralta CA, Siscovick DS, Kestenbaum B, de Boer IH. Serum parathyroid hormone and 25-hydroxyvitamin D concentrations and risk of incident heart failure: the Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc. 2014 Dec 2;3(6).
  5. Zhang S, Hu Y, Zhou L, Chen X, Wang Y, Wu J, He H, Gao Y. Correlations between serum intact parathyroid hormone (PTH) and N-terminal-probrain natriuretic peptide levels in elderly patients with chronic heart failure (CHF). Arch Gerontol Geriatr. 2015 Mar-Apr;60(2):359-65.

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Obesity: the association with excessive parathormone levels (5 references)
  1. Hjelmesaeth J, Hofsø D, Aasheim ET, Jenssen T, Moan J, Hager H, Røislien J, Bollerslev J. Parathyroid hormone, but not vitamin D, is associated with the metabolic syndrome in morbidly obese women and men: a cross-sectional study. Cardiovasc Diabetol. 2009 Feb 3;8:7
  2. Reinehr T, de Sousa G, Alexy U, Kersting M, Andler W. Vitamin D status and parathyroid hormone in obese children before and after weight loss. Eur J Endocrinol. 2007 Aug;157(2):225-32
  3. Bolland MJ, Grey AB, Ames RW, Horne AM, Gamble GD, Reid IR. Fat mass is an important predictor of parathyroid hormone levels in postmenopausal women. Bone. 2006 Mar;38(3):317-21
  4. Gunther CW, Legowski PA, Lyle RM, Weaver CM, McCabe LD, McCabe GP, Peacock M, Teegarden D. Parathyroid hormone is associated with decreased fat mass in young healthy women. Int J Obes (Lond). 2006 Jan;30(1):94-9
  5. Snijder MB, van Dam RM, Visser M, Deeg DJ, Dekker JM, Bouter LM, Seidell JC, Lips Adiposity in relation to vitamin D status and parathyroid hormone levels: a population-based study in older men and women. J Clin Endocrinol Metab. 2005 Jul;90(7):4119-23
Hyperparathyroidism due to limited vitamin D absorption in obese subjects (2 references)
  1. Hamoui N, Kim K, Anthone G, Crookes PF. The significance of elevated levels of parathyroid hormone in patients with morbid obesity before and after bariatric surgery. Arch Surg. 2003 Aug;138(8):891-7.
  2. Andersen T, McNair P, Fogh-Andersen N, Nielsen TT, Hyldstrup L, Transbøl I. Increased parathyroid hormone as a consequence of changed complex binding of plasma calcium in morbid obesity. Metabolism. 1986 Feb;35(2):147-51
Obesity: the improvement with parathormone treatment in vitro (4 references)
  1. Taniguchi A, Kataoka K, Kono T, Oseko F, Okuda H, Nagata I, Imura H. Parathyroid hormone-induced lipolysis in human adipose tissue. J Lipid Res. 1987 May;28(5):490-4
  2. Bagdade J, Yee E, Pykalisto OJ. Parathyroid hormone and triglyceride transport: effects on triglyceride secretion rates and adipose tissue lipoprotein lipase in the rat. Horm Metab Res. 1978 Sep;10(5):443-6
  3. Werner S, Löw H. Stimulation of lipolysis and calcium accumulation by parathyroid hormone in rat adipose tissue in vitro after adrenalectomy and administration of high doses of cortisone acetate. Horm Metab Res. 1973 Jul;5(4):292-6
  4. Querfeld U, Hoffmann MM, Klaus G, Eifinger F, Ackerschott M, Michalk D, Kern PA. Antagonistic effects of vitamin D and parathyroid hormone on lipoprotein lipase in cultured adipocytes. J Am Soc Nephrol. 1999 Oct;10(10):2158-64.
Paresthesias: the association with lower parathormone levels (3 references)
  1. Giusti F, Brandi ML. Clinical Presentation of Hypoparathyroidism. Front Horm Res. 2019;51:139-146.
  2. David K, Moyson C, Vanderschueren D, Decallonne B. Long-term complications in patients with chronic hypoparathyroidism: a cross-sectional study. Eur J Endocrinol. 2019 Jan 1;180(1):71-78.
  3. Quan TT, Li YP, Wang O, Jiang Y, Xia WB, Li M, Cheng XQ, Meng XW, Xing XP.Clinical characteristics of adult-onset primary hypoparathyroidism: a retrospective analysis of 200 cases. Zhonghua Nei Ke Za Zhi. 2017 Jan 1;56(1):19-23.
Hand spasms, spasmophilia: the association with lower parathormone levels (1 reference)
  1. Bringhurst FR, Demay MB, Kronenberg HM. Chapter 241: Hormones and disorders of the mineral metabolism. Hypocalcemic disorders, Clinical presentation, p. 1085. Williams Textbook of Endocrinology, 9th edition, Wilson, Foster, Kronenberg & Larsen editors, WB Saunders Company, 1998
Muscular cramps, including feet and calve cramps (1 reference)
  1. Burckhardt P, Ruedi B, Felber JP. Estrogen-induced tetany in idiopathic hypoparathyroidism. Horm Res. 1975;6(5-6):321-8
Respiratory tract spasms: the association with lower parathormone levels (1 reference)
  1. Giusti F, Brandi ML. Clinical Presentation of Hypoparathyroidism. Front Horm Res. 2019;51:139-146.
Chvostek’s sign: the association with lower parathormone levels (1 reference)
  1. Bringhurst FR, Demay MB, Kronenberg HM. Chapter 241: Hormones and disorders of the mineral metabolism. Hypocalcemic disorders, Clinical presentation, p. 1085. Williams Textbook of Endocrinology, 9th edition, Wilson, Foster, Kronenberg & Larsen editors, WB Saunders Company, 1998  
Trousseau’s sign: the association with lower parathormone levels (1 reference)
  1. Bringhurst FR, Demay MB, Kronenberg HM. Chapter 241: Hormones and disorders of the mineral metabolism. Hypocalcemic disorders, Clinical presentation, p. 1085. Williams Textbook of Endocrinology, 9th edition, Wilson, Foster, Kronenberg & Larsen editors, WB Saunders Company, 1998
Seizures: the association with lower parathormone levels (8 references)
  1. Marcucci G, Cianferotti L, Brandi ML. Clinical presentation and management of hypoparathyroidism. Best Pract Res Clin Endocrinol Metab. 2018 Dec;32(6):927-939.
  2. Giusti F, Brandi ML. Clinical Presentation of Hypoparathyroidism. Front Horm Res. 2019;51:139-146.
  3. David K, Moyson C, Vanderschueren D, Decallonne B. Long-term complications in patients with chronic hypoparathyroidism: a cross-sectional study. Eur J Endocrinol. 2019 Jan 1;180(1):71-78.
  4. Quan TT, Li YP, Wang O, Jiang Y, Xia WB, Li M, Cheng XQ, Meng XW, Xing XP.Clinical characteristics of adult-onset primary hypoparathyroidism: a retrospective analysis of 200 cases. Zhonghua Nei Ke Za Zhi. 2017 Jan 1;56(1):19-23.
  5. Belge H, Dahan K, Cambier JF, Benoit V, Morelle J, Bloch J, Vanhille P, Pirson Y, Demoulin N. Clinical and mutational spectrum of hypoparathyroidism, deafness and renal dysplasia syndrome. Nephrol Dial Transplant. 2017 May 1;32(5):830-837.

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Tetany: the association with lower parathormone levels (1 reference)
  1. Bringhurst FR, Demay MB, Kronenberg HM. Chapter 241: Hormones and disorders of the mineral metabolism. Hypocalcemic disorders, Clinical presentation, p. 1085. Williams Textbook of Endocrinology, 9th edition, Wilson, Foster, Kronenberg & Larsen editors, WB Saunders Company, 1998
Osteoarthritis: the inhibition of progression with parathormone treatment (1 reference)
  1. Chang JK, Chang LH, Hung SH, Wu SC, Lee HY, Lin YS, Chen CH, Fu YC, Wang GJ, Ho ML. Parathyroid hormone 1-34 inhibits terminal differentiation of human articular chondrocytes and osteoarthritis progression in rats. Arthritis Rheum. 2009 Oct;60(10):3049-60
Rheumatoid arthritis: the association with lower parathormone levels (2 references)
  1. Al-Awadhi A, Olusi S, Al-Zaid N, Prabha K. Serum concentrations of interleukin 6, osteocalcin, intact parathyroid hormone, and markers of bone resorption in patients with rheumatoid arthritis. J Rheumatol. 1999 Jun;26(6):1250-6
  2. af Ekenstam E, Benson L, Hällgren R, Wide L, Ljunghall S. Impaired secretion of parathyroid hormone in patients with rheumatoid arthritis: relationship to inflammatory activity. Clin Endocrinol (Oxf). 1990 Mar;32(3):323-8
Rheumatoid arthritis: the improvement with parathormone treatment (1 reference)
  1. Redlich K, Görtz B, Hayer S, Zwerina J, Doerr N, Kostenuik P, Bergmeister H, Kollias G, Steiner G, Smolen JS, Schett G. Repair of local bone erosions and reversal of systemic bone loss upon therapy with anti-tumor necrosis factor in combination with osteoprotegerin or parathyroid hormone in tumor necrosis factor-mediated arthritis. Am J Pathol. 2004 Feb;164(2):543-55

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