Endocrine Abstracts

Introduction: Hypoparathyroidism (hypoPT) is characterized by inadequately low circulating concentrations of parathyroid hormone (PTH) followed by low calcium and increased phosphate levels in the blood. Patients with hypoPT suffer from a number of complications and complaints including infections, neuro-psychiatric diseases, abnormal bone architecture impaired muscle function and reduced quality of life. Due to the complexity of the various clinical manifestations there is a demand for a disease-sensitive control instrument to be able to monitor symptoms beside biochemical values. We used a new disease-characteristic questionnaire to investigate hypoPT patients’ complaints and contributing factors.

Methods: This prospective study was conducted in two endocrinological centers in Germany over one year. Patients with postsurgical hypoPT (n=49) were matched for sex and age ±3 years and compared to patients with thyroid surgery without hypoPT (ThySu, n=39)) and patients with (former) primary hyperparathyroidism (pHPT, n=35). The Hypoparathyroid Patient Questionnaire (HPQ 40) was filled in during the patient’s visit at the center. Information was completed by clinical background information (e.g. disease complications), blood tests and current medication. The influence of these clinical data on patients’ complaints represented as subscales of the HPQ 40 (pain and cramps, depression and anxiety, gastrointestinal symptoms, vitality, neuro-vegetative symptoms) was analyzed.

Results: In hypoPT patients 87% had serum calcium-levels within the target range. Serum-phosphate-levels and calcium-phosphate-product were within reference range in 95.7% of patients, or 100% respectively. The scores for pain and cramps and neuro-vegetative symptoms were significantly elevated in comparison with one (neuro-vegetative symptoms; P=0.002) or both (pain and cramps; P=0.001) control groups. No laboratory parameter correlated with patients’ complaints after Bonferroni correction. In contrast, treatment with alfacalcidol or calcitriol significantly influenced results on different subscales (P=0.002 and P=0.021, respectively).

Conclusions: This study identified pain and cramps and neuro-vegetative symptoms as relevant areas of complaints in predominantly well controlled patients with hypoPT. Our data suggest that different active vitamin D agents may influence certain disease manifestations. The impact of different treatment regimen on clinical manifestations of hypoPT patients should be more intensively investigated.