Hypoparathyroidism natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2]
Overview
The symptoms and complications of hypoparathyroidism usually develop due to hypocalcemia.There is an increased risk of renal complications due to hypercalciuria in patients treated with calcium and vitamin D analogs. Majority of post-surgical patients have transient hypoparathyroidism. The prognosis of post-surgical hypoparathyroidism is usually good as it is transient and serum calcium levels becomes normal within 6 months of surgery. Hypocalcemia due to hypoparathyroidism leads to complications irrespective of treatment. These complications include renal complications and hypocalcemic seizures. Other complications include symptomatic hypocalcemia, basal ganglia calcifications, complications of intravenous calcium extravasation, dilated cardiomyopathy, pathological fractures. Patients on treatment of hypoparathyroidism should be actively monitored for hypercalciuria and renal complications by renal imaging and creatinine clearance.
Natural History, Complications, and Prognosis
Natural History
- The symptoms and complications of hypoparathyroidism usually develop due to hypocalcemia.[1]
- There is an increased risk of renal complications due to hypercalciuria in patients treated with calcium and vitamin D analogs.
- Transient hypoparathyroidism:[2][3][4]
- Most common cause of hypoparathyroidism is anterior neck surgery.
- Majority of post-surgical patients have transient hypoparathyroidism.
- This hypoparathyroidism is due to post-surgical "stunning of parathyroid glands".
- The features of hypoparathyroidism should persist for atleast 6 month after surgery to be diagnosed as chronic hypoparathyroidism.
- Hypocalcemia due to hypoparathyroidism leads to complications irrespective of treatment. The common complications include renal complications and hypocalcemic seizures.[1]
Complications
- Common complications of hypoparathyroidism include:[1][5][6][7]
- Renal complications:
- Symptomatic hypocalcemia
- Posterior subcapsular cataracts
- Basal ganglia calcifications[8]
- Complications of iv calcium extravasation
- Hypocalcemic seizure
- Dilated cardiomyopathy
- Pathological fractures
- Depression and other types of neuropsychiatric diseases
- Increased risk of infections
Prognosis
- The prognosis of post-surgical hypoparathyroidism is usually good as it is transient and serum calcium levels becomes normal within 6 months of surgery.[3][4]
- However, chronic hypoparathyroidism has a negative impact on quality of life of patients.[9][10]
- Hypocalcemia due to hypoparathyroidism leads to complications irrespective of treatment.[1]
- Patients on treatment of hypoparathyroidism should be actively monitored for hypercalciuria and renal complications by renal imaging (X-ray, CT scan without contrast) and creatinine clearance.
References
- ↑ 1.0 1.1 1.2 1.3 Mitchell DM, Regan S, Cooley MR, Lauter KB, Vrla MC, Becker CB, Burnett-Bowie SA, Mannstadt M (2012). "Long-term follow-up of patients with hypoparathyroidism". J. Clin. Endocrinol. Metab. 97 (12): 4507–14. doi:10.1210/jc.2012-1808. PMC 3513540. PMID 23043192.
- ↑ Bilezikian JP, Khan A, Potts JT, Brandi ML, Clarke BL, Shoback D, Jüppner H, D'Amour P, Fox J, Rejnmark L, Mosekilde L, Rubin MR, Dempster D, Gafni R, Collins MT, Sliney J, Sanders J (2011). "Hypoparathyroidism in the adult: epidemiology, diagnosis, pathophysiology, target-organ involvement, treatment, and challenges for future research". J. Bone Miner. Res. 26 (10): 2317–37. doi:10.1002/jbmr.483. PMC 3405491. PMID 21812031.
- ↑ 3.0 3.1 Ritter K, Elfenbein D, Schneider DF, Chen H, Sippel RS (2015). "Hypoparathyroidism after total thyroidectomy: incidence and resolution". J. Surg. Res. 197 (2): 348–53. doi:10.1016/j.jss.2015.04.059. PMC 4466142. PMID 25982044.
- ↑ 4.0 4.1 Sturniolo G, Lo Schiavo MG, Tonante A, D'Alia C, Bonanno L (2000). "Hypocalcemia and hypoparathyroidism after total thyroidectomy: a clinical biological study and surgical considerations". Int. J. Surg. Investig. 2 (2): 99–105. PMID 12678507.
- ↑ Brandi ML, Bilezikian JP, Shoback D, Bouillon R, Clarke BL, Thakker RV, Khan AA, Potts JT (2016). "Management of Hypoparathyroidism: Summary Statement and Guidelines". J. Clin. Endocrinol. Metab. 101 (6): 2273–83. doi:10.1210/jc.2015-3907. PMID 26943719.
- ↑ Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L (2014). "Postsurgical hypoparathyroidism--risk of fractures, psychiatric diseases, cancer, cataract, and infections". J. Bone Miner. Res. 29 (11): 2504–10. doi:10.1002/jbmr.2273. PMID 24806578.
- ↑ Abate EG, Clarke BL (2016). "Review of Hypoparathyroidism". Front Endocrinol (Lausanne). 7: 172. doi:10.3389/fendo.2016.00172. PMC 5237638. PMID 28138323.
- ↑ Goswami R, Sharma R, Sreenivas V, Gupta N, Ganapathy A, Das S (2012). "Prevalence and progression of basal ganglia calcification and its pathogenic mechanism in patients with idiopathic hypoparathyroidism". Clin. Endocrinol. (Oxf). 77 (2): 200–6. doi:10.1111/j.1365-2265.2012.04353.x. PMID 22288727.
- ↑ Cho NL, Moalem J, Chen L, Lubitz CC, Moore FD, Ruan DT (2014). "Surgeons and patients disagree on the potential consequences from hypoparathyroidism". Endocr Pract. 20 (5): 427–46. doi:10.4158/EP13321.OR. PMID 24325999.
- ↑ Arlt W, Fremerey C, Callies F, Reincke M, Schneider P, Timmermann W, Allolio B (2002). "Well-being, mood and calcium homeostasis in patients with hypoparathyroidism receiving standard treatment with calcium and vitamin D". Eur. J. Endocrinol. 146 (2): 215–22. PMID 11834431.