Hypoparathyroidism and pseudohypoparathyroidism: etiology, laboratory features and complications

Lopes, Maicon Piana; Kliemann, Breno S.; Bini, Ileana Borsato; Kulchetscki, Rodrigo; Borsani, Victor; Savi, Larissa; Borba, Victória Zeghbi Cochenski; Moreira, Carolina Aguiar

doi:10.1590/2359-3997000000221

Cited by 44 publications

(40 citation statements)

References 22 publications

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“…This cross-sectional study analyses complications in a cohort of patients with chronic hypoparathyroidism in follow-up at a tertiary endocrine outpatient clinic in Belgium, with particular focus on the role of disease aetiology, risk of renal and cerebral calcifications and risk of seizures. The majority of the patients was female, consistent with other cohorts described in literature (16,17). A substantial proportion of patients had already longlasting disease.…”

Section: Discussionsupporting

confidence: 87%

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Long-term complications in patients with chronic hypoparathyroidism: a cross-sectional study

David

Moyson

Vanderschueren

et al. 2019

European Journal of Endocrinology

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Objective: Chronic hypoparathyroidism and its treatment may lead to symptoms and complications affecting quality of life. We determined complications in chronic hypoparathyroid patients. Design: Retrospective cross-sectional study of patients with chronic hypoparathyroidism treated with active vitamin D supplements in a tertiary care centre during the year 2015. Primary outcome parameters were history of kidney stones and seizures and presence of renal and cerebral calcifications on imaging. Secondary outcome parameters were current symptoms of paraesthesia/cramps, hospitalization due to hyper/hypocalcaemia and hypercalciuria. Subjects: One hundred and seventy patients were included -143 (84%) with post-surgical hypoparathyroidism (PSHP), 16 (9%) with non-surgical hypoparathyroidism (NSHP) and 11 (7%) with pseudo-hypoparathyroidism (PHP). Results: History of kidney stones and seizures was present in 15 and 9% of patients, respectively. Renal and cerebral imaging was performed in 51 and 26% of the patients, with 22 and 25% of these patients having renal and cerebral calcifications respectively. Both history of seizures and cerebral calcifications were significantly more in NSHP and PHP than in PSHP patients. No association was observed between seizures and cerebral calcifications. Cramps/paraesthesia were present in 16%, and hospitalization related to hypocalcaemia was reported in 5% of the patients. Calciuria was screened in 47% at the time of consultation, and in 76% of the patients during the past 5 years. In 36% of these patients, calciuria was increased. Conclusions: Patients with chronic hypoparathyroidism frequently develop ectopic calcifications. Non-surgical patients suffer more from seizures and cerebral calcifications than patients that developed hypoparathyroidism post surgery. There is a need for increased screening of long-term complications, according to the guidelines.

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Section: Discussionsupporting

confidence: 87%

“…Hence, the reported frequency of calcifications and hypercalciuria is a minimum estimate. Lopes et al found no correlation between urinary levels of calcium and presence of calcifications, but 24-h urinary calcium excretion was significantly higher in patients with kidney calcifications compared to patients without calcifications (2,17).…”

Section: Discussionmentioning

confidence: 96%

Long-term complications in patients with chronic hypoparathyroidism: a cross-sectional study

David

Moyson

Vanderschueren

et al. 2019

European Journal of Endocrinology

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“…Generally, the most common cause of hypoparathyroidism is the post‐thyroidectomy condition that makes up 80–90% of cases 61–64 . Interestingly, the development of hypocalcaemic cardiomyopathy is most commonly related to idiopathic hypoparathyroidism ( Figure ).…”

Section: Discussionmentioning

confidence: 99%

Hypocalcaemic cardiomyopathy: a description of two cases and a literature review

et al. 2020

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Hypocalcaemic cardiomyopathy is a rare form of dilated cardiomyopathy. The authors here present two cases in which symptomatic dilated cardiomyopathy was the result of severe hypocalcaemia. First, we report about a 26-year-old woman with primary hypoparathyroidism and then about a 74-year-old man with secondary hypoparathyroidism following a thyroidectomy. In both cases, the left ventricular systolic function improved after calcium supplementation. In the first case, a lack of compliance led to a repeated decrease of both serum calcium level and left ventricular systolic function. The authors also present a comprehensive summary of all cases of hypocalcaemic dilated cardiomyopathy that have been described in literature to date. The mean age of the affected patients was 48.3 years, of which 62% were female patients. The most common causes of hypocalcaemic cardiomyopathy are primary hypoparathyroidism (50%) and post-thyroidectomy hypoparathyroidism (26%). In the post-thyroidectomy subgroup, the median time for the development of hypocalcaemic cardiomyopathy is 10 years (range: 1.5 months to 36 years). Hypocalcaemic cardiomyopathy leads to heart failure with reduced ejection fraction in 87% of patients. Generally, the most common complications of hypoparathyroidism and/or hypocalcaemia are cerebral calcifications, cognitive deficit, and cataracts. Once calcium supplementation is administered, the disease has a good prognosis and, in most individuals, a significant improvement (21%) or even normalization (74%) of the left ventricular systolic function occurs.

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“…To calculate the mean levels of serum calcium, phosphate, and PTH, we analyzed the first and last visits of each patient, as well as three intermediate visits (a total of five time points). We have previously published the mean treatment doses of calcium carbonate, calcitriol, and cholecalciferol used by the patients at five time points during their follow-up (11).…”

Section: Methodsmentioning

confidence: 99%

Self-report of psychological symptoms in hypoparathyroidism patients on conventional therapy

Arneiro¹,

Duarte²,

Kulchetscki³

et al. 2018

Archives of Endocrinology and Metabolism

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Objective: Hypoparathyroidism is characterized by parathyroid hormone deficiency and hypocalcemia. It has been demonstrated that these patients may also present psychiatric symptoms and decrease of quality of life. The aims of this study were to evaluate the presence of psychopathological symptoms in a cohort of patients with hypoparathyroidism and compare to a control group. Subjects and methods: Patients were submitted to a cross-sectional Symptom Checklist-90-R (SCL-90-R) questionnaire that evaluates psychopathological symptoms by means of the Global Severity Index (GSI), Positive Symptoms Total (PST) and Positive Symptom Distress Index (PSDI). A score based in the positive symptoms was calculated (T-score). The test group was composed of patients with hypoparathyroidism, and control by thyroidectomized patients without hypoparathyroidism. A correlation between the presence of psychological symptoms and clinical features was analyzed. Results: The study included 57 patients with a mean age of 51.1 ± 16.4 years; 20 as a control and 37, test group. There were no differences between groups regarding gender, mean age and age at diagnose. Hypoparathyroidism patients presented higher GSI index than the control group (p = 0.038). Mean T-score of the test group was as elevated as 58.2 ± 5.3 (reference range < 55). No correlation of the number of psychological symptoms to clinical and laboratorial parameters was observed. Conclusion: Patients with hypoparathyroidism attending our outpatient clinics presented an increase in the number of self-report of psychological symptoms when compared with a control group. However, no correlation with hypocalcemia and clinical parameters was observed. Future studies are necessary to evaluated if the absence of PTH play a role on it.

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Hypoparathyroidism and pseudohypoparathyroidism: etiology, laboratory features and complications

Cited by 44 publications

References 22 publications

Long-term complications in patients with chronic hypoparathyroidism: a cross-sectional study

Long-term complications in patients with chronic hypoparathyroidism: a cross-sectional study

Hypocalcaemic cardiomyopathy: a description of two cases and a literature review

Self-report of psychological symptoms in hypoparathyroidism patients on conventional therapy

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