Recent advances in understanding and managing hypoparathyroidism

Abstract

Hypoparathyroidism is a rare endocrine disorder which leads to hypocalcemia, hypercalciuria, and hyperphosphatemia. Complications include nephrocalcinosis with renal dysfunction, reduced quality of life, and abnormal skeletal properties. Conventional therapy with calcium and vitamin D analogs addresses hypocalcemia but has important limitations. Parathyroid hormone (PTH) therapy is a fundamental advance, although the effects of PTH on long-term complications require additional testing. Continuous PTH therapy is likely to be particularly advantageous for addressing renal, quality of life, and skeletal complications. Overall, much progress has been made, yet more information is needed to improve our understanding and management of hypoparathyroidism.

Serum calcium levels are associated with cognitive function in hypoparathyroidism: a neuropsychological and biochemical study in an Italian cohort of patients with chronic post-surgical hypoparathyroidism

“…A high prevalence of renal calcifications (31%) and an increased risk of kidney insufficiency [38][39][40][41] have been shown. The skeletal evaluation shows a low bone turnover and impaired microarchitecture, with uncertain fracture risk [3,8].…”

“…The control group included 24 patients without PS-HypoPT, mainly females (n = 21, 83.3%) with a median age of 53 (41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58) years and a median duration of the disease 9.5 years (6)(7)(8)(9)(10)(11)(12)(13).…”

“…Conventional therapy, based on calcium supplements and activated vitamin D, does not completely restore calcium homeostasis [ 8 ]. A step forward has been made with the approval of recombinant human PTH (1–84) [rhPTH(1–84)] for those patients who are not controlled on conventional therapy.…”

Gestione clinica del paziente con ipocalcemia

“…Nel caso specifico di ipocalcemia da ipoparatiroidismo, la terapia orale con calcio e analoghi della vitamina D, pur riportando i valori di calcemia nel range della norma, non ristabilisce tutte le fisiologiche funzioni del PTH. La diponibilità dal 2015 della terapia sostitutiva con PTH umano ricombinante [rhPTH(1-34) e più recentemente rhPTH(1-84)], in caso di controllo non ottimale della malattia in terapia convenzionale, apre nuovi orizzonti per i pazienti affetti da questa patologia [5].…”

Graft Survival Effect of Hla-A Allele Matching Parathyroid Allotransplantation

“…Permanent hypoparathyroidism (PHP) is an endocrine disorder that leads to hypocalcemia, hyperphosphatemia, and hypercalciuria 1 2. Symptomatic treatment requires lifelong medication, such as oral calcium, active vitamin D/analogues, and even intravenous calcium administration.…”