Endocrine Abstracts

Introduction: Patients with permanent hypoparathyroidism receiving conventional treatment have increased risk of subcapsular cataracts, basal ganglia calcifications, urolithiasis and renal insufficiency. The aim of this study was to assess the prevalence and the interfering factors of these complications in patients with permanent hypoparathyroidism.

Methods: We conducted a cross-sectional study including 53 patients with permanent hyperparathyroidism. Biochemical parameters, ophthalmological examination, brain computed tomography scan and renal ultrasound were performed to all patients.

Results: There were 41 (77%) women and 12 (23%) men with a mean age of 52.7 ±16.5 years. Post-surgical HPT was the most frequent etiology of hypoparathyroidism (64%). Posterior subscapular cataract was diagnosed in 62% of cases. Age (P<10^-3), disease duration (P=0.02) and hypomagnesemia (P=0.014) were positively associated with cataracts. Basal ganglia calcifications were found in 53% of cases. Brain CT-scan showed bilateral intracerebral calcifications located in the central gray nuclei (71%) or diffuse symmetric calcifications (29%). Patients with intracranial calcifications presented with headache, amnesic disorders, psychotic symptoms and seizures in 82, 71, 14 and 14% of cases, respectively. Younger age of onset of hypoparathyroidism (P=0.037), disease duration (P=0.014), nonsurgical etiologies (P=0.015), poor adherence to treatment (P<10^-3), hypomagnesemia (P=0.001) and PTH level < 10 pg/ml (P=0.022) were significantly associated with brain calcifications. Urolithiasis and renal insufficiency were found in 13 and 17% of cases, respectively. Creatinine clearance was negatively correlated with disease duration (r= -0.338, P=0.013). Patients with urolithiasis had lower PTH level and received higher calcium salt doses (P=0.033) than those who had no renal calcifications. However, sex, smoking, body mass index, calcemia, phosphatemia, phosphocalcic product, TSH and 25-OH-vitamin D did not significantly interfere with none of these complications.

Conclusion: Patients with permanent hypoparathyroidism are exceedingly exposed to neurological, visual and renal impairment because of phosphocalcic disorders and extra-skeletal calcifications. The disease duration, PTH and magnesium levels seem to be the most interfering factors.