Hipoparatiroidismo: Avances Terapéuticos y Nuevas Perspectivas en la Era de la Hormona Paratiroidea Recombinante

Introduction: Hypoparathyroidism is an endocrinopathy characterized by parathyroid hormone (PTH) deficiency, leading to critical calcium and phosphorus imbalances. This manifests as hypocalcemia, hyperphosphatemia, and a wide range of neuromuscular symptoms and chronic multisystem complications [1], [2]. Post-surgical iatrogenic etiology is the most common, although autoimmune and genetic forms are also relevant [3], [4]. Conventional treatment, based on calcium and vitamin D supplementation, is limited because it does not replicate PTH physiology, resulting in suboptimal calcium control, persistent symptoms, and an increased risk of renal complications, such as nephrocalcinosis and chronic kidney disease [1], [5]. Methodology: This systematic review, covering the literature from January 2020 to February 2026, employed a comprehensive search strategy in databases such as PubMed, SciELO, and Embase, under the PICO model (2550/120), focusing on etiology, pathophysiology, diagnosis, clinical manifestations, and therapeutic advances. Results: The transformative impact of recombinant human PTH (rhPTH) replacement therapies is highlighted. rhPTH (1-84) has proven effective, reducing dependence on supplements and improving biochemical and bone control, although with warnings about potential risks [6], [7]. A significant milestone is palopegteriparatide (TransCon PTH), which has allowed a high percentage of patients to achieve independence from conventional therapy, normalize calcium and phosphorus levels, reduce calciuria, and improve renal function and quality of life [8], [9], [10]. Conclusion: Although hypoparathyroidism remains a challenge, the development of more physiological therapies such as palopegteriparatide offers an improved prognosis and optimized quality of life for patients.