Endocrine Abstracts

Background: Hypoparathyroidism is a rare endocrine disorder characterised by low serum calcium with inappropriately low parathyroid hormone (PTH) levels. Calcium and vitamin D analogues have traditionally been the mainstay of treatment. However, these treatments may cause complications and may not fully address the well-being of this patient group. This study evaluates the current management of hypoparathyroidism in a large UK teaching hospital compared against current European guidelines.

Methods: We identified 164 patients with hypoparathyroidism seen in our Trust between 2012 and 2017. A standardised data proforma was produced, and information gathered to compare management against European Society of Endocrinology guidelines (2015).

Results: The majority of patients had post-surgical hypoparathyroidism. Only 54% had documentation of symptoms at their most recent clinic visit, of these half remained symptomatic. Only 54% of patients had a recent adjusted serum calcium within the recommended range of 2.1–2.3 mmol/l. 81% had a normal serum phosphate. Calcium-phosphate product had not been formally calculated in any patients. 27% of patients had serum magnesium checked within the last 12 months, of which 69% were normal. 145 patients were taking vitamin D analogues, 17% of these were on calcitriol, 83% patients were on alfacalcidol. 11% of patients were on thiazide diuretics and 23% patients were taking phosphate binders. 31% of the cohort had 24 hr urine calcium measurements in the last 24 months, of which 25% showed elevated levels. 16% of patients had an ophthalmic examination. 49% had a renal ultrasound scan performed, of these 24% showed renal calculi or nephrocalcinosis.

Conclusion: In this large cohort of patients adherence to European guidelines for the management of hypoparathyroidism was poor, with evidence of inadequate metabolic control and monitoring. The recent implementation of local guidelines and specialised parathyroid clinics should improve future outcomes for these patients.