Endocrine Abstracts

Hypoparathyroidism is an endocrine disease resulting in hypocalcemia due to inappropriately low circulating parathyroid hormone levels. It is defined as an orphan disease by the European Commission, and commonly managed by endocrinologists and endocrine units. All healthcare personnel involved in the management of patients with chronic hypoparathyroidism should have knowledge about symptoms, treatment and potential complications.

Causes: In adults, hypoparathyroidism most commonly is an acquired condition due to neck surgery or autoimmunity. Idiopathic or autoimmune hypoparathyroidism can occur isolated or in a setting of other associated autoimmune endocrinopathies. In children, adolescents and young adults, underlying genetic conditions have to be considered.

Symptoms: Acute symptoms of hypoparathyroidism are caused by decreasing and low circulating levels of calcium. Patients with rapidly changing calcium levels have more severe symptoms than patients with gradually decreasing levels. In the latter, symptoms can be surprisingly few and weak despite low calcium levels. Common and early neuromuscular symptoms of hypocalcaemia are numbness, tingling and muscle spasm in hands, feet and face. Many patients report muscle stiffness and cramps, slow thinking, lack of concentration and initiative, often described as ‘brain fog’. Severe hypocalcaemia can result in life threatening symptoms as tetany, seizures, larynx spasms and ventricular arrhythmias. In patients with chronic hypoparathyroidism, it is important to have basic knowledge about symptoms and treatment of hypercalcemia as overtreatment frequently occurs. Symptoms of hypercalcemia include: nausea, anorexia, constipation, polyuria, dehydration, bradycardia, muscle weakness, confusion and coma.

Treatment and management: As primary treatment, activated vitamin D analogues (calcitriol and alfacalcidiol) plus calcium supplements in divided doses are recommended. Treatment should aim serum calcium levels in the low normal range and serum phosphate within the normal range. A high intake of Calcium supplements (> 1000 mg/day) should be avoided. Sufficient dietary intake or supplement of magnesium and conventional vitamin D (cholecalciferol or ergocalciferol), and a phosphate low diet may result in more stable serum calcium levels and lower risk for long term complications. Recently, a synthetic PTH-analogue has become commercially available. This replacement therapy may improve treatment. But so far, this treatment is costly and there is only limited documentation of improved outcomes. The lecture will focus on a patient orientated, team based approach in the management of chronic endocrine conditions as hypoparathyroidism. Team based endocrine care should include assessment of symptoms, eventually aided by disease specific questionnaires, patient education, nutritional advice and follow up of compliance of pharmacologic treatment.