Hypoparathyroidism natural history, complications and prognosis: Difference between revisions
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==Overview== | ==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 | 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 [[Hypocalcemia|hypocalcemic]] [[Seizure|seizures]]. Other complications include [[symptomatic]] [[hypocalcemia]], [[Basal ganglia calcification|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, Complications, and Prognosis== | ||
===Natural History=== | ===Natural History=== | ||
*The symptoms and complications of hypoparathyroidism usually develop due to [[hypocalcemia]].<ref name="pmid23043192">{{cite journal |vauthors=Mitchell DM, Regan S, Cooley MR, Lauter KB, Vrla MC, Becker CB, Burnett-Bowie SA, Mannstadt M |title=Long-term follow-up of patients with hypoparathyroidism |journal=J. Clin. Endocrinol. Metab. |volume=97 |issue=12 |pages=4507–14 |year=2012 |pmid=23043192 |pmc=3513540 |doi=10.1210/jc.2012-1808 |url=}}</ref> | *The [[symptoms]] and complications of hypoparathyroidism usually develop due to [[hypocalcemia]].<ref name="pmid23043192">{{cite journal |vauthors=Mitchell DM, Regan S, Cooley MR, Lauter KB, Vrla MC, Becker CB, Burnett-Bowie SA, Mannstadt M |title=Long-term follow-up of patients with hypoparathyroidism |journal=J. Clin. Endocrinol. Metab. |volume=97 |issue=12 |pages=4507–14 |year=2012 |pmid=23043192 |pmc=3513540 |doi=10.1210/jc.2012-1808 |url=}}</ref> | ||
*There is an increased risk of [[renal]] complications due to [[hypercalciuria]] in patients treated with [[calcium]] and [[vitamin D]] analogs. | *There is an increased risk of [[renal]] complications due to [[hypercalciuria]] in patients treated with [[calcium]] and [[vitamin D]] analogs. | ||
*'''Transient hypoparathyroidism:'''<ref name="pmid21812031">{{cite journal |vauthors=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 |title=Hypoparathyroidism in the adult: epidemiology, diagnosis, pathophysiology, target-organ involvement, treatment, and challenges for future research |journal=J. Bone Miner. Res. |volume=26 |issue=10 |pages=2317–37 |year=2011 |pmid=21812031 |pmc=3405491 |doi=10.1002/jbmr.483 |url=}}</ref><ref name="pmid25982044">{{cite journal |vauthors=Ritter K, Elfenbein D, Schneider DF, Chen H, Sippel RS |title=Hypoparathyroidism after total thyroidectomy: incidence and resolution |journal=J. Surg. Res. |volume=197 |issue=2 |pages=348–53 |year=2015 |pmid=25982044 |pmc=4466142 |doi=10.1016/j.jss.2015.04.059 |url=}}</ref><ref name="pmid12678507">{{cite journal |vauthors=Sturniolo G, Lo Schiavo MG, Tonante A, D'Alia C, Bonanno L |title=Hypocalcemia and hypoparathyroidism after total thyroidectomy: a clinical biological study and surgical considerations |journal=Int. J. Surg. Investig. |volume=2 |issue=2 |pages=99–105 |year=2000 |pmid=12678507 |doi= |url=}}</ref> | *'''Transient hypoparathyroidism:'''<ref name="pmid21812031">{{cite journal |vauthors=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 |title=Hypoparathyroidism in the adult: epidemiology, diagnosis, pathophysiology, target-organ involvement, treatment, and challenges for future research |journal=J. Bone Miner. Res. |volume=26 |issue=10 |pages=2317–37 |year=2011 |pmid=21812031 |pmc=3405491 |doi=10.1002/jbmr.483 |url=}}</ref><ref name="pmid25982044">{{cite journal |vauthors=Ritter K, Elfenbein D, Schneider DF, Chen H, Sippel RS |title=Hypoparathyroidism after total thyroidectomy: incidence and resolution |journal=J. Surg. Res. |volume=197 |issue=2 |pages=348–53 |year=2015 |pmid=25982044 |pmc=4466142 |doi=10.1016/j.jss.2015.04.059 |url=}}</ref><ref name="pmid12678507">{{cite journal |vauthors=Sturniolo G, Lo Schiavo MG, Tonante A, D'Alia C, Bonanno L |title=Hypocalcemia and hypoparathyroidism after total thyroidectomy: a clinical biological study and surgical considerations |journal=Int. J. Surg. Investig. |volume=2 |issue=2 |pages=99–105 |year=2000 |pmid=12678507 |doi= |url=}}</ref> | ||
**Most common cause of hypoparathyroidism is anterior [[neck surgery]]. | **Most common cause of hypoparathyroidism is [[anterior]] [[neck surgery]]. | ||
**Majority of post-surgical patients have transient hypoparathyroidism. | **Majority of post-surgical patients have transient hypoparathyroidism. | ||
**This hypoparathyroidism is due to post-surgical "stunning of [[Parathyroid gland|parathyroid glands]]". | **This hypoparathyroidism is due to post-surgical "stunning of [[Parathyroid gland|parathyroid glands]]". | ||
*The features of hypoparathyroidism should persist for atleast 6 month after surgery to be diagnosed as chronic hypoparathyroidism. | *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. | *[[Hypocalcemia]] due to hypoparathyroidism leads to complications irrespective of treatment. The common complications include [[renal]] complications and [[Hypocalcemia|hypocalcemic]] [[seizures]].<ref name="pmid23043192">{{cite journal |vauthors=Mitchell DM, Regan S, Cooley MR, Lauter KB, Vrla MC, Becker CB, Burnett-Bowie SA, Mannstadt M |title=Long-term follow-up of patients with hypoparathyroidism |journal=J. Clin. Endocrinol. Metab. |volume=97 |issue=12 |pages=4507–14 |year=2012 |pmid=23043192 |pmc=3513540 |doi=10.1210/jc.2012-1808 |url=}}</ref> | ||
===Complications=== | ===Complications=== | ||
*Common complications of hypoparathyroidism include:<ref name="pmid23043192">{{cite journal |vauthors=Mitchell DM, Regan S, Cooley MR, Lauter KB, Vrla MC, Becker CB, Burnett-Bowie SA, Mannstadt M |title=Long-term follow-up of patients with hypoparathyroidism |journal=J. Clin. Endocrinol. Metab. |volume=97 |issue=12 |pages=4507–14 |year=2012 |pmid=23043192 |pmc=3513540 |doi=10.1210/jc.2012-1808 |url=}}</ref><ref name="pmid26943719">{{cite journal |vauthors=Brandi ML, Bilezikian JP, Shoback D, Bouillon R, Clarke BL, Thakker RV, Khan AA, Potts JT |title=Management of Hypoparathyroidism: Summary Statement and Guidelines |journal=J. Clin. Endocrinol. Metab. |volume=101 |issue=6 |pages=2273–83 |year=2016 |pmid=26943719 |doi=10.1210/jc.2015-3907 |url=}}</ref> | *Common complications of hypoparathyroidism include:<ref name="pmid23043192">{{cite journal |vauthors=Mitchell DM, Regan S, Cooley MR, Lauter KB, Vrla MC, Becker CB, Burnett-Bowie SA, Mannstadt M |title=Long-term follow-up of patients with hypoparathyroidism |journal=J. Clin. Endocrinol. Metab. |volume=97 |issue=12 |pages=4507–14 |year=2012 |pmid=23043192 |pmc=3513540 |doi=10.1210/jc.2012-1808 |url=}}</ref><ref name="pmid26943719">{{cite journal |vauthors=Brandi ML, Bilezikian JP, Shoback D, Bouillon R, Clarke BL, Thakker RV, Khan AA, Potts JT |title=Management of Hypoparathyroidism: Summary Statement and Guidelines |journal=J. Clin. Endocrinol. Metab. |volume=101 |issue=6 |pages=2273–83 |year=2016 |pmid=26943719 |doi=10.1210/jc.2015-3907 |url=}}</ref><ref name="pmid24806578">{{cite journal |vauthors=Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L |title=Postsurgical hypoparathyroidism--risk of fractures, psychiatric diseases, cancer, cataract, and infections |journal=J. Bone Miner. Res. |volume=29 |issue=11 |pages=2504–10 |year=2014 |pmid=24806578 |doi=10.1002/jbmr.2273 |url=}}</ref><ref name="pmid28138323">{{cite journal |vauthors=Abate EG, Clarke BL |title=Review of Hypoparathyroidism |journal=Front Endocrinol (Lausanne) |volume=7 |issue= |pages=172 |year=2016 |pmid=28138323 |pmc=5237638 |doi=10.3389/fendo.2016.00172 |url=}}</ref> | ||
**Renal complications: | **[[Renal]] complications: | ||
***[[Nephrolithiasis]] | ***[[Nephrolithiasis]] | ||
***[[Nephrocalcinosis]] | ***[[Nephrocalcinosis]] | ||
***[[Impaired renal function]] | ***[[Impaired renal function]] | ||
**Symptomatic [[hypocalcemia]] | **[[Symptomatic]] [[hypocalcemia]] | ||
** | **Posterior subcapsular [[cataracts]] | ||
**[[Basal ganglia calcification|Basal ganglia calcifications]]<ref name="pmid22288727">{{cite journal |vauthors=Goswami R, Sharma R, Sreenivas V, Gupta N, Ganapathy A, Das S |title=Prevalence and progression of basal ganglia calcification and its pathogenic mechanism in patients with idiopathic hypoparathyroidism |journal=Clin. Endocrinol. (Oxf) |volume=77 |issue=2 |pages=200–6 |year=2012 |pmid=22288727 |doi=10.1111/j.1365-2265.2012.04353.x |url=}}</ref> | **[[Basal ganglia calcification|Basal ganglia calcifications]]<ref name="pmid22288727">{{cite journal |vauthors=Goswami R, Sharma R, Sreenivas V, Gupta N, Ganapathy A, Das S |title=Prevalence and progression of basal ganglia calcification and its pathogenic mechanism in patients with idiopathic hypoparathyroidism |journal=Clin. Endocrinol. (Oxf) |volume=77 |issue=2 |pages=200–6 |year=2012 |pmid=22288727 |doi=10.1111/j.1365-2265.2012.04353.x |url=}}</ref> | ||
**Complications of [[Calcium gluconate|iv calcium]] extravasation | **Complications of [[Calcium gluconate|iv calcium]] extravasation | ||
**Hypocalcemic [[seizure]] | **[[Hypocalcemia|Hypocalcemic]] [[seizure]] | ||
**[[Dilated cardiomyopathy]] | **[[Dilated cardiomyopathy]] | ||
** | **Pathological [[fractures]] | ||
**[[Depression]] and other types of [[psychiatric disorders|neuropsychiatric diseases]] | |||
**Increased risk of [[infections]] | |||
===Prognosis=== | ===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.<ref name="pmid25982044">{{cite journal |vauthors=Ritter K, Elfenbein D, Schneider DF, Chen H, Sippel RS |title=Hypoparathyroidism after total thyroidectomy: incidence and resolution |journal=J. Surg. Res. |volume=197 |issue=2 |pages=348–53 |year=2015 |pmid=25982044 |pmc=4466142 |doi=10.1016/j.jss.2015.04.059 |url=}}</ref><ref name="pmid12678507">{{cite journal |vauthors=Sturniolo G, Lo Schiavo MG, Tonante A, D'Alia C, Bonanno L |title=Hypocalcemia and hypoparathyroidism after total thyroidectomy: a clinical biological study and surgical considerations |journal=Int. J. Surg. Investig. |volume=2 |issue=2 |pages=99–105 |year=2000 |pmid=12678507 |doi= |url=}}</ref> | *The [[prognosis]] of post-surgical hypoparathyroidism is usually good as it is transient and [[serum]] [[calcium]] levels becomes normal within 6 months of [[surgery]].<ref name="pmid25982044">{{cite journal |vauthors=Ritter K, Elfenbein D, Schneider DF, Chen H, Sippel RS |title=Hypoparathyroidism after total thyroidectomy: incidence and resolution |journal=J. Surg. Res. |volume=197 |issue=2 |pages=348–53 |year=2015 |pmid=25982044 |pmc=4466142 |doi=10.1016/j.jss.2015.04.059 |url=}}</ref><ref name="pmid12678507">{{cite journal |vauthors=Sturniolo G, Lo Schiavo MG, Tonante A, D'Alia C, Bonanno L |title=Hypocalcemia and hypoparathyroidism after total thyroidectomy: a clinical biological study and surgical considerations |journal=Int. J. Surg. Investig. |volume=2 |issue=2 |pages=99–105 |year=2000 |pmid=12678507 |doi= |url=}}</ref> | ||
*However, chronic hypoparathyroidism has a negative impact on quality of life of patients.<ref name="pmid24325999">{{cite journal |vauthors=Cho NL, Moalem J, Chen L, Lubitz CC, Moore FD, Ruan DT |title=Surgeons and patients disagree on the potential consequences from hypoparathyroidism |journal=Endocr Pract |volume=20 |issue=5 |pages=427–46 |year=2014 |pmid=24325999 |doi=10.4158/EP13321.OR |url=}}</ref><ref name="pmid11834431">{{cite journal |vauthors=Arlt W, Fremerey C, Callies F, Reincke M, Schneider P, Timmermann W, Allolio B |title=Well-being, mood and calcium homeostasis in patients with hypoparathyroidism receiving standard treatment with calcium and vitamin D |journal=Eur. J. Endocrinol. |volume=146 |issue=2 |pages=215–22 |year=2002 |pmid=11834431 |doi= |url=}}</ref> | |||
*[[Hypocalcemia]] due to [[hypoparathyroidism]] leads to complications irrespective of treatment.<ref name="pmid23043192">{{cite journal |vauthors=Mitchell DM, Regan S, Cooley MR, Lauter KB, Vrla MC, Becker CB, Burnett-Bowie SA, Mannstadt M |title=Long-term follow-up of patients with hypoparathyroidism |journal=J. Clin. Endocrinol. Metab. |volume=97 |issue=12 |pages=4507–14 |year=2012 |pmid=23043192 |pmc=3513540 |doi=10.1210/jc.2012-1808 |url=}}</ref> | *[[Hypocalcemia]] due to [[hypoparathyroidism]] leads to complications irrespective of treatment.<ref name="pmid23043192">{{cite journal |vauthors=Mitchell DM, Regan S, Cooley MR, Lauter KB, Vrla MC, Becker CB, Burnett-Bowie SA, Mannstadt M |title=Long-term follow-up of patients with hypoparathyroidism |journal=J. Clin. Endocrinol. Metab. |volume=97 |issue=12 |pages=4507–14 |year=2012 |pmid=23043192 |pmc=3513540 |doi=10.1210/jc.2012-1808 |url=}}</ref> | ||
*Patients on treatment of hypoparathyroidism should be actively monitored for [[hypercalciuria]] and [[renal]] complications by renal imaging and [[creatinine clearance]]. | *Patients on treatment of hypoparathyroidism should be actively monitored for [[hypercalciuria]] and [[renal]] complications by renal imaging ([[X-ray]], [[Computed tomography|CT scan]] without contrast) and [[creatinine clearance]]. | ||
==References== | ==References== | ||
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{{WH}} | {{WH}} | ||
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[[Category:Disease]] | |||
[[Category:Medicine]] | |||
[[Category:Endocrinology]] | |||
[[Category:Parathyroid disorders]] | |||
[[Category:Up-To-Date]] | |||
Latest revision as of 22:18, 29 July 2020
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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.