Etiology and Pathophysiology of Hypoparathyroidism: A Narrative Review

Abstract

The approach utilized a systematic review of the medical literature executed with specifically designed criteria that focused on the etiologies and pathogenesis of hypoparathyroidism. Enhanced attention by endocrine surgeons to new knowledge about parathyroid gland viability are reviewed along with the role of intraoperative parathyroid hormone (ioPTH) monitoring during and after neck surgery. Nonsurgical etiologies account for a significant proportion of cases of hypoparathyroidism (~25%), and among them, genetic etiologies are key. Given the pervasive nature of PTH deficiency across multiple organ systems, a detailed review of the skeletal, renal, neuromuscular, and ocular complications is provided. The burden of illness on affected patients and their caregivers contributes to reduced quality of life and social costs for this chronic endocrinopathy. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Hypoparathyroidism: update of guidelines from the 2022 International Task Force

“…In patients with nonsurgical HypoPT who have a positive family history of nonsurgical HypoPT or present with syndromic features, or are younger than 40 years, genetic testing is recommended (3,4,10). In patients with nonsurgical HypoPT who have other clinical features of autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) syndrome, genetic testing for AIRE variants is recommended.…”

“…C are of patients with parathyroid disorders is often challenging due to complexities in the diagnosis, imaging, and surgical or medical management of primary hyperparathyroidism, and inadequacies with conventional management of hypoparathyroidism. This review summarizes recommendations from the 2 nd International Guidelines for Hypoparathyroidism (1) that will soon be published in the Journal of Bone and Mineral Research, along with the supporting systematic and narrative reviews (2)(3)(4)(5). These guidelines summarize information published in the medical literature back as far as 1940, with particular focus on papers published between 1970 and 2020, and emphasizing new information published between 2015 and 2020.…”

The Fifth International Workshop on the Evaluation and Management of Primary Hyperparathyroidism

“…The reports on hypoparathyroidism are published in a contiguous issue of JBMR. (22)(23)(24)(25)(26)(27)(28) In the commentary introducing those reports, we gratefully acknowledge those who were involved in that major effort. (29) Ever mindful of this international effort, we have reached out to many organizations, societies, and patient advocacy groups.…”

The Second International Workshop on the Evaluation and Management of Hypoparathyroidism

“…Strategies to minimize the risk of postsurgical HypoPT are presented. ( 6 ) The role of genetic testing in determining the underlying etiology of the HypoPT has been highlighted, as well as an approach to establishing the underlying diagnosis. ( 7 )…”

“…(2)(3)(4) In addition, narrative reviews were completed regarding the epidemiology, financial burden, and etiology of HypoPT. (5,6) The diagnosis and risk factors for the development of postsurgical HypoPT were reviewed. Strategies to minimize the risk of postsurgical HypoPT are presented.…”