Chronic hypoparathyroidism and its treatment may lead to symptoms and complications affecting quality of life. We determined complications in chronic hypoparathyroid patients.
Retrospective cross-sectional study of patients with chronic hypoparathyroidism treated with active vitamin D supplements in a tertiary care centre during the year 2015. Primary outcome parameters were history of kidney stones and seizures and presence of renal and cerebral calcifications on imaging. Secondary outcome parameters were current symptoms of paraesthesia/cramps, hospitalization due to hyper/hypocalcaemia and hypercalciuria.
One hundred and seventy patients were included – 143 (84%) with post-surgical hypoparathyroidism (PSHP), 16 (9%) with non-surgical hypoparathyroidism (NSHP) and 11 (7%) with pseudo-hypoparathyroidism (PHP).
History of kidney stones and seizures was present in 15 and 9% of patients, respectively. Renal and cerebral imaging was performed in 51 and 26% of the patients, with 22 and 25% of these patients having renal and cerebral calcifications respectively. Both history of seizures and cerebral calcifications were significantly more in NSHP and PHP than in PSHP patients. No association was observed between seizures and cerebral calcifications. Cramps/paraesthesia were present in 16%, and hospitalization related to hypocalcaemia was reported in 5% of the patients. Calciuria was screened in 47% at the time of consultation, and in 76% of the patients during the past 5 years. In 36% of these patients, calciuria was increased.
Patients with chronic hypoparathyroidism frequently develop ectopic calcifications. Non-surgical patients suffer more from seizures and cerebral calcifications than patients that developed hypoparathyroidism post surgery. There is a need for increased screening of long-term complications, according to the guidelines.
BilezikianJPKhanAPottsJTJrBrandiMLClarkeBLShobackDJüppnerHD’AmourPFoxJRejnmarkLet al. Hypoparathyroidism in the adult: epidemiology, diagnosis, pathophysiology, target-organ involvement, treatment, and challenges for future research. Journal of Bone and Mineral Research2011262317–2337. (https://doi.org/10.1002/jbmr.483)
ClarkeBLBrownEMCollinsMTJüppnerHLakatosPLevineMAMannstadtMMBilezikianJPRomanischenAFThakkerRV.Epidemiology and diagnosis of hypoparathyroidism. Journal of Clinical Endocrinology and Metabolism20161012284–2299. (https://doi.org/10.1210/jc.2015-3908)
ShobackDMBilezikianJPCostaAGDempsterDDralleHKhanAAPeacockMRaffaelliMSilvaBCThakkerRVet al. Presentation of hypoparathyroidism: etiologies and clinical features. Journal of Clinical Endocrinology and Metabolism20161012300–2312. (https://doi.org/10.1210/jc.2015-3909)
UnderbjergLSikjaerTMosekildeLRejnmarkL.Cardiovascular and renal complications to postsurgical hypoparathyroidism: a Danish nationwide controlled historic follow-up study. Journal of Bone and Mineral Research201382277–2285. (https://doi.org/10.1002/jbmr.1979)
UnderbjergLSikjaerTMosekildeLRejnmarkL.The epidemiology of nonsurgical hypoparathyroidism in Denmark: a Nationwide case finding study. Journal of Bone and Mineral Research2015301738–1744. (https://doi.org/10.1002/jbmr.2501)
ClarkeBLLeibsonCEmersonJRansomJELagastH. Co-morbid medical conditions associated with prevalent hypoparathyroidism: a population-based study. Journal of Bone and Mineral Research201126(Supplement 1) (Abstract SA1070).
BilezikianJPBrandiMLCusanoNEMannstadtMRejnmarkLRizzoliRRubinMRWinerKKLibermanUAPottsJTJr. Management of hypoparathyroidism: present and future. Journal of Clinical Endocrinology and Metabolism20161012313–2324. (https://doi.org/10.1210/jc.2015-3910)
UnderbjergLSikjaerTRejnmarkL.Long-term complications in patients with hypoparathyroidism evaluated by biochemical findings: a case-control study. Journal of Bone and Mineral Research201833822–831. (https://doi.org/10.1002/jbmr.3368)
AlmquistMIvarssonKNordenströmEBergenfelzA.Mortality in patients with permanent hypoparathyroidism after total thyroidectomy. British Journal of Surgery20181051313–1318. (https://doi.org/10.1002/bjs.10843)
BollerslevJRejnmarkLMarcocciCShobackDMSitges-SerraAvan BiesenWDekkersOM.European Society of Endocrinology Clinical Guideline: treatment of chronic hypoparathyroidism in adults. European Journal of Endocrinology2015173G1–G20. (https://doi.org/10.1530/EJE-15-0628)
StackBCJrBimstonDNBodennerDLBrettEMDralleHOrloffLAPallotaJSnyderSKWongRJet al. American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Review: postoperative hypoparathyroidism – definitions and management. Endocrine Practice201521674–685. (https://doi.org/10.4158/EP14462.DSC)
LeveyASStevensLASchmidCHZhangYLCastroAF3rdFeldmanHIKusekJWEggersPVan LenteFGreeneTet al. A new equation to estimate glomerular filtration rate. Annals of Internal Medicine2009150604–612. (https://doi.org/10.7326/0003-4819-150-9-200905050-00006)
MitchellDMReganSCooleyMRLauterKBVrlaMCBeckerCBBurnett-BowieSAMannstadtM.Long-term follow-up of patients with hypoparathyroidism. Journal of Clinical Endocrinology and Metabolism2012974507–4514. (https://doi.org/10.1210/jc.2012-1808)
LopesMPKliemannBSBiniIBKulchetschkiRBorsaniVSaviLBorbaVZMoreiraCA.Hypoparathyroidism and pseudohypoparathyroidism: etiology, laboratory features and complications. Archives of Endocrinology and Metabolism201660532–536. (https://doi.org/10.1590/2359-3997000000221)
ArltWFremereyCCalliesFReinckeMSchneiderPTimmermannWAllolioB.Well-being, mood and calcium homeostasis in patients with hypoparathyroidism receiving standard treatment with calcium and vitamin D. European Journal of Endocrinology2002146215–222. (https://doi.org/10.1530/eje.0.1460215)
UnderbjergLSikjaerTRejnmarkL.Health-related quality of life in patients with nonsurgical hypoparathyroidism and pseudohypoparathyroidism. Clinical Endocrinology201888838–847. (https://doi.org/10.1111/cen.13593)
VokesTJMannstadtMLevineMAClarkeBLLakatosPChenKPiccoloRKrasnerAShobackDMBilezikianJP.Recombinant human parathyroid hormone effect on health-related quality of life in adults with chronic hypoparathyroidism. Journal of Clinical Endocrinology and Metabolism2018103722–731. (https://doi.org/10.1210/jc.2017-01471)
OkanoKFurukawaYMoriiHFujitaT.Comparative efficacy of various vitamin D metabolites in the treatment of various types of hypoparathyroidism. Journal of Clinical Endocrinology and Metabolism198255238–243. (https://doi.org/10.1210/jcem-55-2-238)
StreetenEAMohtasebiYKonigMDavidoffLRyanK.Hypoparathyroidism: less severe hypocalcemia with treatment with vitamin D2 compared to calcitriol. Journal of Clinical Endocrinology and Metabolism20171021505–1510. (https://doi.org/10.1210/jc.2016-3712)
MannstadtMClarkeBLVokesTBrandiMLRanganathLFraserWDLakatosPBajnokLGarceauRMosekildeLet al. Efficacy and safety of recombinant human parathyroid hormone (1–84) in hypoparathyroidism (REPLACE): a double-blind, placebo-controlled, randomized, phase 3 study. Lancet Diabetes and Endocrinology20131275–283. (https://doi.org/10.1016/S2213-8587(13)70106-2)
AndrewsEBGilsenanAWMidkiffKSherrillBWuYMannBHMasicaD. The US postmarketing surveillance study of adult osteosarcoma and teriparatide: study design and finding from the first 7 years. Journal of Bone and Mineral Research2012272429–2437. (https://doi.org/10.1002/jbmr.1768)
GoswamiRSharmaRSreenivasVGuptaNGanapthyADasS. Prevalence and progression of basal ganglia calcification and its pathogenic mechanism in patients with idiopathic hypoparathyroidism. Clinical Endocrinology201277200–206. (https://doi.org/10.1111/j.1365-2265.2012.04353.x)
AggarwalSKailashSSagarRTripathiMSreenivasVSharmaRGuptaNGoswamiR.Neuropsychological dysfunction in idiopathic hypoparathyroidism and its relationship with intracranial calcification and serum total calcium. European Journal of Endocrinology2013168895–903. (https://doi.org/10.1530/EJE-12-0946)