Chronic hypoparathyroidism in adults: clinical features, diagnosis, management and treatment
https://doi.org/10.14341/omet9699
Abstract
Hypoparathyroidism is a rare сalcium and phosphate metabolic disorder. Most often it develops after neck surgery. The recent studies show increased morbidity in thyroid and parathyroid pathology wich are the most common causes of hypoparathyroidism. Thus makes this problem more relevant and urgent. Management of a patient with chronic hypoparathyroidism is based on personalized treatment regimen, disease monitoring and prevention of therapy adverse events.
About the Authors
Natalia G. MokryshevaEndocrinology Research centre
Russian Federation
Sc.D., prof.
Anna K. Eremkina
Endocrinology Research centre
Russian Federation
Ph.D.
Elena V. Kovaleva
Endocrinology Research centre
Russian Federation
postgraduate student
References
1. Powers J, Joy K, Ruscio A, Lagast H. Prevalence and Incidence of Hypoparathyroidism in the United States Using a Large Claims Database. J Bone Miner Res. 2013;28(12):2570-2576. doi: 10.1002/jbmr.2004
2. Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L. The Epidemiology of Nonsurgical Hypoparathyroidism in Denmark: A Nationwide Case Finding Study. J Bone Miner Res. 2015;30(9):1738-1744. doi: 10.1002/jbmr.2501
3. Astor MC, Løvås K, Debowska A, et al. Epidemiology and Health-Related Quality of Life in Hypoparathyroidism in Norway. J Clin Endocrinol Metab. 2016;101(8):3045-3053. doi: 10.1210/jc.2016-1477
4. Clarke BL, Brown EM, Collins MT, et al. Epidemiology and Diagnosis of Hypoparathyroidism. J Clin Endocrinol Metab. 2016;101(6):2284-2299. doi: 10.1210/jc.2015-3908
5. Kakava K, Tournis S, Papadakis G, et al. Postsurgical Hypoparathyroidism: A Systematic Review. In Vivo. 2016;30(3):171-179. PMID: 27107072
6. Edafe O, Antakia R, Laskar N, et al. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg. 2014;101(4):307-320. doi: 10.1002/bjs.9384
7. Eisenbarth GS, Gottlieb PA. Autoimmune Polyendocrine Syndromes. N Engl J Med. 2004;350(20):2068-2079. doi: 10.1056/NEJMra030158
8. Goldmuntz E. DiGeorge Syndrome: New Insights. Clin Perinatol. 2005;32(4):963-978. doi: 10.1016/J.CLP.2005.09.006
9. Thakker RV. Genetic developments in hypoparathyroidism. Lancet. 2001;357(9261):974-976. doi: 10.1016/S0140-6736(00)04254-9
10. Мокрышева Н.Г., Еремкина А.К., Ковалева Е.В. Гипопаратиреоз: этиология, клиническая картина, современные методы диагностики и лечения. Альманах клинической медицины. – 2016. – Т.44. – №4. – C.477-492. [Mokrysheva NG, Eremkina AK, Kovaleva EV. Hypoparathyroidism: etiology, clinical manifestation, current diagnostics and treatment. Al’manah kliničeskoj mediciny. 2016;44(4):477-492. (In Russ).] doi: 10.18786/2072-0505-2016-44-4-477-492
11. Mannstadt M, Bilezikian JP, Thakker RV, et al. Hypoparathyroidism. Nat Rev Dis Prim. 2017;3:17055. doi: 10.1038/nrdp.2017.55
12. Frankenhaeuser B, Hodgkin AL. The action of calcium on the electrical properties of squid axons. J Physiol. 1957;137(2):218-244. doi: 10.1113/jphysiol.1957.sp005808
13. Williams GT, Brown M. Laryngospasm in hypoparathyroidism. J Laryngol Otol. 1974;88(04):369-374. doi: 10.1017/S0022215100078804
14. Chou CT, Siegel B, Mehta D. Stridor and apnea as the initial presentation of primary hypoparathyroidism. Int J Pediatr Otorhinolaryngol. 2016;80:30-32. doi: 10.1016/j.ijporl.2015.11.023
15. Jesus JE, Landry A. Chvostek’s and Trousseau’s Signs. N Engl J Med. 2012;367(11):e15. doi: 10.1056/NEJMicm1110569
16. Mitchell DM, Regan S, Cooley MR, et al. Long-Term Follow-Up of Patients with Hypoparathyroidism. J Clin Endocrinol Metab. 2012;97(12):4507-4514. doi: 10.1210/jc.2012-1808
17. Goswami R, Sharma R, Sreenivas V, et al. Prevalence and progression of basal ganglia calcification and its pathogenic mechanism in patients with idiopathic hypoparathyroidism. Clin Endocrinol (Oxf). 2012;77(2):200-206. doi: 10.1111/j.1365-2265.2012.04353.x
18. Legati A, Giovannini D, Nicolas G, et al. Mutations in XPR1 cause primary familial brain calcification associated with altered phosphate export. Nat Genet. 2015;47(6):579-581. doi: 10.1038/ng.3289
19. Wang C, Li Y, Shi L, et al. Mutations in SLC20A2 link familial idiopathic basal ganglia calcification with phosphate homeostasis. Nat Genet. 2012;44(3):254-256. doi: 10.1038/ng.1077
20. ABE S, TOJO K, ICHIDA K, et al. A Rare Case of Idiopathic Hypoparathyroidism with Varied Neurological Manifestations. Intern Med. 1996;35(2):129-134. doi: 10.2169/internalmedicine.35.129
21. Vered I, Vered Z, Perez JE, et al. Normal left ventricular performance documented by doppler echocardiography in patients with long-standing hypocalcemia. Am J Med. 1989;86(4):413-416. doi: 10.1016/0002-9343(89)90338-0
22. Newman DB, Fidahussein SS, Kashiwagi DT, et al. Reversible cardiac dysfunction associated with hypocalcemia: a systematic review and meta-analysis of individual patient data. Heart Fail Rev. 2014;19(2):199-205. doi: 10.1007/s10741-013-9371-1
23. Prakash M, Gupta Y, Bhadada S, et al. Carotid, aorta and renal arteries intima-media thickness in patients with sporadic idiopathic hypoparathyroidism. Indian J Endocrinol Metab. 2015;19(2):262-266. doi: 10.4103/2230-8210.149320
24. Cohen GI, Aboufakher R, Bess R, et al. Relationship Between Carotid Disease on Ultrasound and Coronary Disease on CT Angiography. JACC Cardiovasc Imaging. 2013;6(11):1160-1167. doi: 10.1016/j.jcmg.2013.06.007
25. Agarwal P, Prakash M, Singhal M, et al. To assess vascular calcification in the patients of hypoparathyroidism using multidetector computed tomography scan. Indian J Endocrinol Metab. 2015;19(6):785-790. doi: 10.4103/2230-8210.167545
26. Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L. Cardiovascular and renal complications to postsurgical hypoparathyroidism: A Danish nationwide controlled historic follow-up study. J Bone Miner Res. 2013;28(11):2277-2285. doi: 10.1002/jbmr.1979
27. Levy I, Licht C, Daneman A, et al. The Impact of Hypoparathyroidism Treatment on the Kidney in Children: Long-Term Retrospective Follow-Up Study. J Clin Endocrinol Metab. 2015;100(11):4106-4113. doi: 10.1210/jc.2015-2257
28. Clarke BL. Bone disease in hypoparathyroidism. Arq Bras Endocrinol Metabol. 2014;58(5):545-552. doi: 10.1590/0004-2730000003399
29. Silva BC, Rubin MR, Cusano NE, Bilezikian JP. Bone imaging in hypoparathyroidism. Osteoporos Int. 2017;28(2):463-471. doi: 10.1007/s00198-016-3750-0
30. Dempster DW. Bone Histomorphometry in Hypoparathyroidism. In: Brandi ML, Brown EM, editors. Hypoparathyroidism. Milano: Springer Milan; 2015:287-296. doi: 10.1007/978-88-470-5376-2_26
31. Rubin MR, Dempster DW, Sliney Jr. J, et al. PTH (1-84) administration reverses abnormal bone-remodeling dynamics and structure in hypoparathyroidism. J Bone Miner Res. 2011;26(11):2727-2736. doi: 10.1002/jbmr.452
32. Rubin MR, Dempster DW, Zhou H, et al. Dynamic and Structural Properties of the Skeleton in Hypoparathyroidism. J Bone Miner Res. 2008;23(12):2018-2024. doi: 10.1359/jbmr.080803
33. Rubin MR, Dempster DW, Kohler T, et al. Three dimensional cancellous bone structure in hypoparathyroidism. Bone. 2010;46(1):190-195. doi: 10.1016/j.bone.2009.09.020
34. Sikjaer T, Rejnmark L, Thomsen JS, et al. Changes in 3-dimensional bone structure indices in hypoparathyroid patients treated with PTH (1-84): A randomized controlled study. J Bone Miner Res. 2012;27(4):781-788. doi: 10.1002/jbmr.1493
35. Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L. Postsurgical Hypoparathyroidism-Risk of Fractures, Psychiatric Diseases, Cancer, Cataract, and Infections. J Bone Miner Res. 2014;29(11):2504-2510. doi: 10.1002/jbmr.2273
36. Mendonça ML, Pereira FA, Nogueira-Barbosa MH, et al. Increased vertebral morphometric fracture in patients with postsurgical hypoparathyroidism despite normal bone mineral density. BMC Endocr Disord. 2013;13(1):1. doi: 10.1186/1472-6823-13-1
37. Jakkani RK, Sureka J, Mathew J. Spondyloarthropathy occurring in long-standing idiopathic hypoparathyroidism. Radiol Case Reports. 2011;6(4):545. doi: 10.2484/rcr.v6i4.545
38. Goswami R, Ray D, Sharma R, et al. Presence of spondyloarthropathy and its clinical profile in patients with hypoparathyroidism. Clin Endocrinol (Oxf). 2008;68(2):258-263. doi: 10.1111/j.1365-2265.2007.03032.x
39. Policepatil SM, Caplan RH, Dolan M. Hypocalcemic myopathy secondary to hypoparathyroidism. WMJ. 2012;111(4):173-175. PMID:22970532
40. Dai CL, Dai C, Sun ZJ, et al. Elevated muscle enzymes and muscle biopsy in idiopathic hypoparathyroidism patients. J Endocrinol Invest. 2012;35(3):286-289. doi: 10.3275/7679
41. Sikjaer T, Moser E, Rolighed L, et al. Concurrent Hypoparathyroidism Is Associated With Impaired Physical Function and Quality of Life in Hypothyroidism. J Bone Miner Res. 2016;31(7):1440-1448. doi: 10.1002/jbmr.2812
42. BÖRGLUM JENSEN S, ILLUM F, DUPONT E. Nature and frequency of dental changes in idiopathic hypoparathyroidism and pseudohypoparathyroidism. Eur J Oral Sci. 1981;89(1):26-37. doi: 10.1111/j.1600-0722.1981.tb01274.x
43. Srirangarajan S, Satyanarayan A, Ravindra S, Thakur S. Dental manifestation of primary idiopathic hypoparathyroidism. J Indian Soc Periodontol. 2014;18(4):524-526. doi: 10.4103/0972-124X.138755
44. STEINBERG H, WALDRON BR. IDIOPATHIC HYPOPARATHYROIDISM. Medicine (Baltimore). 1952;31(2):133-154. doi: 10.1097/00005792-195205000-00001
45. Arlt W, Fremerey C, Callies F, et al. Well-being, mood and calcium homeostasis in patients with hypoparathyroidism receiving standard treatment with calcium and vitamin D. Eur J Endocrinol. 2002;146(2):215-222. doi: 10.1530/eje.0.1460215
46. Saha S, Gantyala SP, Aggarwal S, et al. Long-term outcome of cataract surgery in patients with idiopathic hypoparathyroidism and its relationship with their calcemic status. J Bone Miner Metab. 2017;35(4):405-411. doi: 10.1007/s00774-016-0767-6
47. Мальчугина А.А., Атарщиков Д.С., Липатов Д.В., Мельниченко Г.А. Гипопаратиреоз и катаракта // Клиническая и экспериментальная тиреодология. – 2009. – Т.5. – №4. – C.9-14. [Mal'chugina AA, Atarshchikov DS, Lipatov DV, Mel'nichenko GA. Gipoparatireoz i katarakta. «Kliničeskaâ i èksperimental’naâ tireoidologiâ» («Сlinical and experimental thyroidology»). 2009;5(4):9-14 (In Russ).] doi: 10.14341/ket2009549-14
48. Huang Q.L. Clinical observations and calcium determinations in hypocalcemic cataract. Zhonghua Yan Ke Za Zhi. 1989; 25(5):268–270. PMID: 2633901
49. Ayuk J, Matthews T, Tayebjee M, Gittoes NJ. A blind panic. Lancet. 2001;357(9264):1262. doi: 10.1016/S0140-6736(00)04408-1
50. Sarkar S, Mondal M, Das K, Shrimal A. Mucocutaneous manifestations of acquired hypoparathyroidism: An observational study. Indian J Endocrinol Metab. 2012;16(5):819-820. doi: 10.4103/2230-8210.100637
51. Guerreiro de Moura CAG, de Assis LH, Góes P, et al. A Case of Acute Generalized Pustular Psoriasis of von Zumbusch Triggered by Hypocalcemia. Case Rep Dermatol. 2015;7(3):345-351. doi: 10.1159/000442380
52. Hadker N, Egan J, Sanders J, Lagast H, Clarke B. Understanding the Burden of Illness Associated with Hypoparathyroidism Reported Among Patients in the Paradox Study. Endocr Pract. 2014;20(7):671-679. doi: 10.4158/EP13328.OR
53. Bollerslev J, Rejnmark L, Marcocci C, et al. European Society of Endocrinology Clinical Guideline: Treatment of chronic hypoparathyroidism in adults. Eur J Endocrinol. 2015;173(2):G1-20. doi: 10.1530/EJE-15-0628
54. Stack BC, Bimston DN, Bodenner DL, et al. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY DISEASE STATE CLINICAL REVIEW: POSTOPERATIVE HYPOPARATHYROIDISM – DEFINITIONS AND MANAGEMENT. Endocr Pract. 2015;21(6):674-685. doi: 10.4158/EP14462.DSC
55. Middler S, Pak CYC, Murad F, Bartter FC. Thiazide diuretics and calcium metabolism. Metabolism. 1973;22(2):139-146. doi: 10.1016/0026-0495(73)90264-3
56. Porter RH, Cox BG, Heaney D, et al. Hostetter TH, Stinebaugh BJ, Suki WN. Treatment of Hypoparathyroid Patients with Chlorthalidone. N Engl J Med. 1978;298(11):577-581. doi: 10.1056/NEJM197803162981101
57. Abate EG, Clarke BL. Review of Hypoparathyroidism. Front Endocrinol (Lausanne). 2017;7:172. doi: 10.3389/fendo.2016.00172
58. Vetter T, Lohse MJ. Magnesium and the parathyroid. Curr Opin Nephrol Hypertens. 2002;11(4):403-410. doi: 10.1097/00041552-200207000-00006
59. Мокрышева Н.Г., Еремкина А.К., Ковалева Е.В., Крупинова Ю.А. Рекомбинантный паратиреоидный гормон человека в терапии гипопаратиреоза // Терапевтический архив. – 2017. – Т.89. – №10. – C.80-86. [Eremkina AK, Mokrysheva NG, Kovaleva EV, Krupinova YA. Recombinant human parathyroid hormone in the therapy of hypoparathyroidism. Therapeutic archive. 2017;89(10):80-86. (In Russ).] doi: 10.17116/terarkh2017891080-86.
Supplementary files
|
1. Fig. 1. Clinical manifestations of hypoparathyroidism (according to materials of Mannstadt M. et al. [11]). | |
Subject | ||
Type | Исследовательские инструменты | |
View
(504KB)
|
Indexing metadata ▾ |
|
2. Fig. 2. Trusso's test, "the hand of an obstetrician." Symptom tail. | |
Subject | ||
Type | Исследовательские инструменты | |
View
(155KB)
|
Indexing metadata ▾ |
|
3. Fig. 3. The dynamic control algorithm for the management of patients with chronic hypoparathyroidism (based on European clinical guidelines for the management of patients with hypoparathyroidism, 2015 [53]). | |
Subject | ||
Type | Исследовательские инструменты | |
View
(234KB)
|
Indexing metadata ▾ |
Review
For citations:
Mokrysheva N.G., Eremkina A.K., Kovaleva E.V. Chronic hypoparathyroidism in adults: clinical features, diagnosis, management and treatment. Obesity and metabolism. 2018;15(4):74-82. (In Russ.) https://doi.org/10.14341/omet9699

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0).