Recalcitrant hypocalcaemia responding to teriparatide therapy: a clinical insight

Hypocalcaemia is a common metabolic abnormality in neonates, with distinct causes based on the timing of onset. Early-onset hypocalcaemia (within 72 hours of life) is typically related to transitional physiology, prematurity, perinatal asphyxia or maternal diabetes. In contrast, late-onset hypocalcaemia (after 72 hours) is less common and may result from high phosphate intake, cow's milk-based formulas, vitamin D deficiency or resistance, maternal vitamin D deficiency, hypoparathyroidism (eg, DiGeorge syndrome), magnesium deficiency or activating mutations in the calcium-sensing receptor. Clinical manifestations of late-onset hypocalcaemia can include seizures, tetany, irritability, arrhythmias or stridor. While most cases respond to oral calcium, vitamin D and magnesium supplementation, some are refractory to conventional therapy. We report a case of refractory neonatal hypocalcaemia that showed significant improvement with teriparatide, a recombinant parathyroid hormone analogue, highlighting the potential role of advanced pharmacological agents in difficult-to-treat cases of neonatal hypocalcaemia.