Effect of postsurgical chronic hypoparathyroidism on morbidity and mortality: a systematic review and meta-analysis

Hadedeya, Deena; Kay, Joshua B.; Attia, Abdallah S.; Omar, Mahmoud; Shalaby, Mahmoud; Youssef, Mohanad R.; Shama, Mohamed; Toraih, Eman A.; Kandil, Emad

doi:10.21037/gs-21-181

Cited by 7 publications

(7 citation statements)

References 35 publications

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“…The non-surgical hypoparathyroid patients were of younger age and had signifi cantly lower levels of serum calcium and magnesium. All the hypoparathyroid patients, their families and treating physicians should be better informed about upto-date guidelines on hypoPT [32] and the possible impact of suboptimal treatment on morbidity and mortality in hypoparathyroid subjects [33,34]. Unfortunately, we do not know with certainty yet, whether the introduction of treatment of hypoPT with rhPTH might be of substantial benefi t to our not well-controlled patients [35].…”

Section: Discussionmentioning

confidence: 99%

Biochemical Control of 78 Patients with Chronic Hypoparathyroidism Referred between 2006 and 2020 – Where do We Actually Stand?

Boyanov

Zamfirova

Bakalov

et al. 2023

Acta Medica Bulgarica

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Hypoparathyroidism (hypoPT) is a relatively rare endocrine disease, mainly due to thyroid surgery. The classical supplementation with calcium and active vitamin D may represent a challenge to the clinician. Objective To describe the level of biochemical control in patients with chronic hypoPT and to look for differences between postsurgical and non-surgical cases referred between 2006 and 2020. Materials and Methods This was a retrospective cross-sectional study with data review from the database of a tertiary endocrine clinic from the last 15 years. Cases with hypocalcemia not related to PTH were excluded. The patients’ medical history was reviewed as well as concomitant diseases and medications. Serum calcium (total, albumin-corrected and ionized; sCa, corrCa, iCa+) and phosphates (P), magnesium, creatinine, alkaline phosphatase together with 24hr urinary calcium and phosphate were measured. The intact parathyroid hormone (iPTH) was determined by electro-hemi-luminescence (Elecsys, Roche Diagnostics). Thyroid and abdominal ultrasound (US) were both performed. Results Seventy-eight patients met the study criteria – 69 were females. Most of them were between 30 and 60 years (mean age 50.6 ± 14.5 years). Albumin-corrected calcium was in target in 20.5% of the patients, ionized calcium – in 36.5%, serum phosphate – in 46.3%, serum magnesium – in 87.9%. When all four parameters were taken together, less than 20% were in target. Hypercalciuria was registered in 11.8%, while 57.1% of the patients had nephrolithiasis and 27.3% had CKD grade 3-4. Thus, a high proportion of patients with kidney involvement was identified. Calcium carbonate and calcitriol were the preferred replacement choices. Comparing patients with post-surgical and non-surgical hypoPT significant differences were found only for age, total serum calcium, serum magnesium and TSH. Conclusion Our study is the first of its kind in our country during the last two decades describing the contemporary clinical and biochemical picture of chronic hypoPT in patients referred for specialized care. Low supplementation doses leading to hypocalcemia and hyperphosphatemia were a common finding. Low patient’s adherence may be just one possible explanation. Non-surgical cases tend to have even lower calcium and magnesium levels. The patients, their families and treating physicians should be better informed about up-to-date management of chronic hypoPT and the possible impact of suboptimal treatment on morbidity and mortality of the affected subjects.

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Section: Discussionmentioning

confidence: 99%

Biochemical Control of 78 Patients with Chronic Hypoparathyroidism Referred between 2006 and 2020 – Where do We Actually Stand?

Boyanov

Zamfirova

Bakalov

et al. 2023

Acta Medica Bulgarica

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“…Conventional therapy of HypoPT with calcium supplements and active vitamin D may result in hypercalciuria, which is a risk factor for nephrolithiasis and nephrocalcinosis (53). An increased risk of chronic kidney disease (CKD) (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m 2 ) has also been described in patients with HypoPT on conventional therapy (5,8,37,39,40,43,(52)(53)(54)(55). A recent systematic review reported higher rates of nephrolithiasis (up to 36%) and CKD (up to 41%) in chronic HypoPT than in the general population (53).…”

Section: Renal Complicationsmentioning

confidence: 99%

“…Seizures can also occur as a neurological manifestation of hypocalcemia in HypoPT ( 7 , 9 , 15 , 43 ). They are particularly common in patients with nonsurgical disease ( 8 , 39 ) and can be generalized tonic-clonic or, less frequently, petit mal, partial, or atonic ( 44 ).…”

Section: Introductionmentioning

confidence: 99%

Skeletal and nonskeletal consequences of hypoparathyroidism

Silva¹

2022

Archives of Endocrinology and Metabolism

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Hypoparathyroidism, despite the conventional therapy with calcium and active vitamin D, can lead to skeletal and nonskeletal abnormalities. Chronic hypoparathyroidism is associated with a significant reduction in bone remodeling, increases in areal and volumetric bone density, and improvement in trabecular microarchitecture and in trabecular bone score. Regardless of these advantages in bone mass and microarchitecture, recent data suggest an increased vertebral fracture risk in patients with nonsurgical hypoparathyroidism. Moreover, chronic hypoparathyroidism can lead to abnormalities in multiple organ systems, including the neurological, cardiovascular, renal, neuropsychiatric, ocular, and immune systems. Nephrocalcinosis, nephrolithiasis, and renal insufficiency, as well as decreased quality of life and cataracts, are common in patients with hypoparathyroidism. An increased incidence of hospitalization due to infections and a greater risk of cardiovascular diseases are observed in patients with hypoparathyroidism, particularly in those with nonsurgical disease. All these abnormalities may be because of the disease itself or complications of therapy. We herein reviewed the skeletal and nonskeletal consequences of hypoparathyroidism in patients conventionally managed with calcium and active vitamin D.

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“…(1) Conflicting results also exist on the clinical significance of HP with regard to mortality as some studies report a higher mortality in HP while others do not find such a correlation. (2)(3)(4) Acute symptoms are most commonly triggered by hypocalcemia. They include muscle spasms, paresthesia, shortness of breath or even potentially life-threatening conditions like laryngospasm or arrhythmia.…”

Section: Introduction Backgroundmentioning

confidence: 99%

Hospitalizations, emergency room visits and causes of death in 198 patients with permanent hypoparathyroidism: a retrospective Austrian study (2005–2022)

Herteux

Geiger

Starchl

et al. 2023

Endocrine Connections

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Objective: Chronic hypoparathyroidism (HP) is associated with acute and chronic complications, especially those related to hypocalcemia. We aimed to analyze details on hospital admissions and the reported deaths in affected patients. Design and methods: In a retrospective analysis, we reviewed the medical history of 198 patients diagnosed with chronic HP over a continuous period of up to 17 years at the Medical University Graz. Results: The mean age in our mostly female cohort (70.2%) was 62.6  18.7 years. The etiology was predominantly postsurgical (84.8%). 87.4% of patients received standard medication (oral calcium/vitamin D), 15 patients (7.6%) used rhPTH1-84/Natpar and 10 patients (4.5%) had no/unknown medication. 219 ER visits and 627 hospitalizations were documented among 149 patients, 49 patients (24.7%) did not record any hospital admissions. According to symptoms and decreased calcium levels, 12% of ER (n = 26) visits and 7% of hospitalizations (n = 44) were likely attributable to HP. A subgroup of 13 patients (6.5%) received kidney transplants prior to the HP diagnosis. In 8 of these patients, parathyroidectomy for tertiary renal hyperparathyroidism was the cause of permanent HP. The mortality was 7.8% (n = 12) and the causes of death appeared to be unrelated to HP. Although, the awareness for HP was low, calcium levels were documented in 71% (n = 447) of hospitalizations. Conclusions: Acute symptoms directly related to HP did not represent the primary cause of ER visits. However, comorbidities (e.g. renal/cardiovascular diseases) associated with HP played a key role in hospitalizations and deaths.

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Effect of postsurgical chronic hypoparathyroidism on morbidity and mortality: a systematic review and meta-analysis

Cited by 7 publications

References 35 publications

Biochemical Control of 78 Patients with Chronic Hypoparathyroidism Referred between 2006 and 2020 – Where do We Actually Stand?

Biochemical Control of 78 Patients with Chronic Hypoparathyroidism Referred between 2006 and 2020 – Where do We Actually Stand?

Skeletal and nonskeletal consequences of hypoparathyroidism

Hospitalizations, emergency room visits and causes of death in 198 patients with permanent hypoparathyroidism: a retrospective Austrian study (2005–2022)

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