Teriparatide

Abstract

Headache, fatigue and myalgia following off-label use: case report A 41-year-old woman developed headache, fatigue and myalgia during off-label treatment with teriparatide for hypocalcaemia. The woman, presented with hypocalcaemia in July 2018. In 2006, she had underwent an adjustable gastric banding, followed by secondary sleeve gastrectomy two years later. In 2014, she underwent Roux-en-Y gastric bypass (RYGB) due to weight regain after an initial decrease. Then, in June 2017, a total thyroidectomy was performed for a cold nodule in the right thyroidal lobe. Postoperatively, she developed primary hypoparathyroidism that resulted in recalcitrant hypocalcaemia. On current presentation, with hypocalcaemia and symptoms of paraesthesia and muscle cramps in both hands, despite high doses of calcium and activated oral vitamin-D substitution. She was admitted and treated with high doses of calcium citrate, calcitriol, colecalciferol, chlortalidone and calcium gluconate for hypocalcaemia; but there was inadequate response to these therapy. Thus, she started receiving off-label subcutaneous teriparatide 20μg daily along with ongoing therapy. After 1 week, symptoms improved and serum calcium levels increased. However, teriparatide therapy was discontinued due to developed of headaches, fatigue and myalgia [duration of treatment to reactions onsets not stated]. Therefore, IV calcium remained necessary twice a week. Therefore, when all other treatments had failed a reversal of the RYGB was warranted. Despite, reversal of the RYGB, she still did not had a sustained increase in serum calcium and remained dependent on IV calcium due to persistent hypocalcaemia. No other postoperative complications occurred, but she did however start to regain weight [outcomes not stated].