Standards of care for hypoparathyroidism in adults: a Canadian and International Consensus

Author:

Khan Aliya A1,Koch Christian A2,Van Uum Stan3,Baillargeon Jean Patrice4,Bollerslev Jens5,Brandi Maria Luisa6,Marcocci Claudio7,Rejnmark Lars8,Rizzoli Rene9,Shrayyef M Zakarea10,Thakker Rajesh11,Yildiz Bulent O12,Clarke Bart13

Affiliation:

1. 1McMaster University, Hamilton, Ontario, Canada

2. 2Technische Universitat Dresden, Dresden, Germany

3. 3Western University, London, Ontario, Canada

4. 4Université de Sherbrooke, Sherbrooke, Quebec, Canada

5. 5Oslo University Hospital, Oslo, Norway

6. 6University of Florence, Florence, Italy

7. 7University of Pisa, Pisa, Italy

8. 8Aarhus University, Aarhus C, Denmark

9. 9University Hospital of Geneva, Geneva, Switzerland

10. 10University of Toronto, Toronto, Canada

11. 11University of Oxford, Oxford, UK

12. 12Hacettepe University School of Medicine, Ankara, Turkey

13. 13Mayo Clinic, Rochester, Minnesota, USA

Abstract

Purpose: To provide practice recommendations for the diagnosis and management of hypoparathyroidism in adults. Methods: Key questions pertaining to the diagnosis and management of hypoparathyroidism were addressed following a literature review. We searched PubMed, MEDLINE, EMBASE and Cochrane databases from January 2000 to March 2018 using keywords ‘hypoparathyroidism, diagnosis, treatment, calcium, PTH, calcidiol, calcitriol, hydrochlorothiazide and pregnancy’. Only English language papers involving humans were included. We excluded letters, reviews and editorials. The quality of evidence was evaluated based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. These standards of care for hypoparathyroidism have been endorsed by the Canadian Society of Endocrinology and Metabolism. Results: Hypoparathyroidism is a rare disease characterized by hypocalcemia, hyperphosphatemia and a low or inappropriately normal serum parathyroid hormone level (PTH). The majority of cases are post-surgical (75%) with nonsurgical causes accounting for the remaining 25% of cases. A careful review is required to determine the etiology of the hypoparathyroidism in individuals with nonsurgical disease. Hypoparathyroidism is associated with significant morbidity and poor quality of life. Treatment requires close monitoring as well as patient education. Conventional therapy with calcium supplements and active vitamin D analogs is effective in improving serum calcium as well as in controlling the symptoms of hypocalcemia. PTH replacement is of value in lowering the doses of calcium and active vitamin D analogs required and may be of value in lowering long-term complications of hypoparathyroidism. This manuscript addresses acute and chronic management of hypoparathyroidism in adults. Main conclusions: Hypoparathyroidism requires careful evaluation and pharmacologic intervention in order to improve serum calcium and control the symptoms of hypocalcemia. Frequent laboratory monitoring of the biochemical profile and patient education is essential to achieving optimal control of serum calcium.

Publisher

Bioscientifica

Subject

Endocrinology,General Medicine,Endocrinology, Diabetes and Metabolism

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