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Eur J Endocrinol. 2018 Dec 1. pii: EJE-18-0609.R1. doi: 10.1530/EJE-18-0609. [Epub ahead of print]

Standards of Care for Hypoparathyroidism in Adults.

Author information

1
A Khan, Medicine, Divisions of Endocrinology and Metabolism and Geriatric Medicine, McMaster University , Oakville, Canada.
2
C Koch, Medicine, Technische Universitat Dresden, Dresden, Germany.
3
S Van Uum, Medicine, University of Western Ontario, London, N6A 4V2, Canada.
4
J Baillargeon, Medicine, Universite de Sherbrooke Faculte de medecine et des sciences de la sante, Sherbrooke, Canada.
5
J Bollerslev, Section of Specialized Endocrinology, Oslo University Hospital, Oslo, 0027, Norway.
6
M Brandi, Department of Surgery and Translational Medicine, University of Florence, Florence, 50139, Italy.
7
C Marcocci, Clinical and Experimental Medicine, University of Pisa, Pisa, 56124, Italy.
8
L Rejnmark, Dept of Endocrinology and Metabolism, Aarhus University Hospital, Aarhus, 8000, Denmark.
9
R Rizzoli, Division of Bone Diseases, University Hospitals and Faculty of Medicine of Geneva, Geneva, 1211, Switzerland.
10
M Shrayyef, Medicine, University of Toronto, Toronto, Canada.
11
R Thakker, Nuffield Department of Clinical Medicine, University of Oxford, Academic Endocrine Unit, Oxford, OX3 7LJ, United Kingdom of Great Britain and Northern Ireland.
12
B Yildiz, Dept of Internal Medicine, Endocrinology and Metabolism Unit, Hacettepe University School of Medicine, Ankara, 06100, Turkey.
13
B Clarke, Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA, Rochester, United States.

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 analogues is effective in improving serum calcium as well as in controlling the symptoms of hypocalcemia. Parathyroid hormone replacement is of value in lowering the doses of calcium and active vitamin D analogues 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.

PMID:
30540559
DOI:
10.1530/EJE-18-0609

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