Hypoparathyroidism natural history, complications and prognosis: Difference between revisions
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===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 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. These complications include renal complications and | *[[Hypocalcemia]] due to hypoparathyroidism leads to complications irrespective of treatment. These complications include [[renal]] complications and 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> | *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> | ||
**Renal complications: | **Renal complications: | ||
***Nephrolithiasis | ***[[Nephrolithiasis]] | ||
***Nephrocalcinosis | ***[[Nephrocalcinosis]] | ||
***Impaired renal function | ***[[Impaired renal function]] | ||
**Symptomatic hypocalcemia | **Symptomatic [[hypocalcemia]] | ||
**Symptomatic hypercalcemia | **Symptomatic [[hypercalcemia]] | ||
**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 iv calcium extravasation | **Complications of [[Calcium gluconate|iv calcium]] extravasation | ||
** | **Hypocalcemic [[seizure]] | ||
**Dilated cardiomyopathy | **[[Dilated cardiomyopathy]] | ||
**Pathologic fractures | **Pathologic fractures | ||
===Prognosis=== | ===Prognosis=== | ||
*The prognosis of post-surgical hypoparathyroidism is 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> | ||
*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 | *Patients on treatment of hypoparathyroidism should be actively monitored for [[hypercalciuria]] and [[renal]] complications by renal imaging and [[creatinine clearance]]. | ||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
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. These complications include renal complications and hypocalcemic seizures.[1]
Complications
- Common complications of hypoparathyroidism include:[1]
- Renal complications:
- Symptomatic hypocalcemia
- Symptomatic hypercalcemia
- Basal ganglia calcifications[5]
- Complications of iv calcium extravasation
- Hypocalcemic seizure
- Dilated cardiomyopathy
- Pathologic fractures
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]
- 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 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.
- ↑ 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.