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Hypoparathyroidism

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Metabolic Bone Diseases

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Abstract

Hypoparathyroidism is a relatively uncommon disease; however, it is one which can be associated with a high degree of disease burden. We present here a case of presumed autoimmune hypoparathyroidism which was difficult to manage until the recent use of recombinant human parathyroid hormone (rhPTH) for the treatment of hypoparathyroidism. The potential etiologies of hypoparathyroidism as well as initial evaluation will be reviewed here. The clinical course of disease and treatment requirements can vary significantly between patients. We will discuss the general approach to management which has historically consisted of calcium and vitamin D supplementation and for some patients now also includes rhPTH. The use of rhPTH has been shown to significantly reduce the need for calcium and vitamin D supplementation as well as lead to improvement in quality of life which is not observed only with normalization of calcium levels via repletion. Finally, we will review data regarding bone health in those with hypoparathyroidism. Bone structure and remodeling is abnormal in those with hypoparathyroidism even with replacement of calcium and vitamin D although the exact effect of altered bone quality on fracture risk remains unclear.

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References

  1. Bilezikian JP, et al. Hypoparathyroidism in the adult: epidemiology, diagnosis, pathophysiology, target-organ involvement, treatment, and challenges for future research. J Bone Miner Res. 2011;26(10):2317–37.

    Article  CAS  Google Scholar 

  2. Clarke BL, et al. Epidemiology and diagnosis of hypoparathyroidism. J Clin Endocrinol Metab. 2016;101(6):2284–99.

    Article  CAS  Google Scholar 

  3. Shoback D. Clinical practice. Hypoparathyroidism. N Engl J Med. 2008;359(4):391–403.

    Article  CAS  Google Scholar 

  4. Arlt W, et al. Well-being, mood and calcium homeostasis in patients with hypoparathyroidism receiving standard treatment with calcium and vitamin D. Eur J Endocrinol. 2002;146(2):215–22.

    Article  CAS  Google Scholar 

  5. Rubin MR, Levine MA. Hypoparathyroidism and pseudohypoparathyroidism. In: Rosen CJ, editor. Primer on the metabolic bone diseases and disorders of mineral metabolism. Ames, Iowa : Wiley-Blackwell, 2013.

    Chapter  Google Scholar 

  6. Khan MI, Waguespack SG, Hu MI. Medical management of postsurgical hypoparathyroidism. Endocr Pract. 2011;17(Suppl 1):18–25.

    Article  Google Scholar 

  7. Hannan FM, Thakker RV. Calcium-sensing receptor (CaSR) mutations and disorders of calcium, electrolyte and water metabolism. Best Pract Res Clin Endocrinol Metab. 2013;27(3):359–71.

    Article  CAS  Google Scholar 

  8. Marx SJ. Hyperparathyroid and hypoparathyroid disorders. N Engl J Med. 2000;343(25):1863–75.

    Article  CAS  Google Scholar 

  9. Thakker RV. Genetics of endocrine and metabolic disorders: parathyroid. Rev Endocr Metab Disord. 2004;5(1):37–51.

    Article  CAS  Google Scholar 

  10. Rubin MR, et al. Dynamic and structural properties of the skeleton in hypoparathyroidism. J Bone Miner Res. 2008;23(12):2018–24.

    Article  CAS  Google Scholar 

  11. Rude RK, et al. Parathyroid hormone secretion in magnesium deficiency. J Clin Endocrinol Metab. 1978;47(4):800–6.

    Article  CAS  Google Scholar 

  12. Tong GM, Rude RK. Magnesium deficiency in critical illness. J Intensive Care Med. 2005;20(1):3–17.

    Article  Google Scholar 

  13. Cholst IN, et al. The influence of hypermagnesemia on serum calcium and parathyroid hormone levels in human subjects. N Engl J Med. 1984;310(19):1221–5.

    Article  CAS  Google Scholar 

  14. Brandi ML, et al. Management of Hypoparathyroidism: summary statement and guidelines. J Clin Endocrinol Metab. 2016;101(6):2273–83.

    Article  CAS  Google Scholar 

  15. Schafer AL, Shoback DM. Hypocalcemia: definition, etiology, pathogenesis, diagnosis, and management. In: Rosen CJ, editor. Primer on the metabolic bone diseases and disorders of mineral metabolism. Ames: Wiley; 2013.

    Google Scholar 

  16. Harvey JA, Zobitz MM, Pak CY. Dose dependency of calcium absorption: a comparison of calcium carbonate and calcium citrate. J Bone Miner Res. 1988;3(3):253–8.

    Article  CAS  Google Scholar 

  17. Natpara (parathyroid hormone) [package insert]. NPS Pharmaceuticals, NJ; 2015. 2015.

    Google Scholar 

  18. Winer KK, Yanovski JA, Cutler GB Jr. Synthetic human parathyroid hormone 1-34 vs calcitriol and calcium in the treatment of hypoparathyroidism. JAMA. 1996;276(8):631–6.

    Article  CAS  Google Scholar 

  19. Winer KK, et al. A randomized, cross-over trial of once-daily versus twice-daily parathyroid hormone 1-34 in treatment of hypoparathyroidism. J Clin Endocrinol Metab. 1998;83(10):3480–6.

    CAS  PubMed  Google Scholar 

  20. Winer KK, et al. Long-term treatment of hypoparathyroidism: a randomized controlled study comparing parathyroid hormone-(1-34) versus calcitriol and calcium. J Clin Endocrinol Metab. 2003;88(9):4214–20.

    Article  CAS  Google Scholar 

  21. Winer KK, et al. Synthetic human parathyroid hormone 1-34 replacement therapy: a randomized crossover trial comparing pump versus injections in the treatment of chronic hypoparathyroidism. J Clin Endocrinol Metab. 2012;97(2):391–9.

    Article  CAS  Google Scholar 

  22. Cusano NE, et al. Therapy of hypoparathyroidism with PTH(1-84): a prospective four-year investigation of efficacy and safety. J Clin Endocrinol Metab. 2013;98(1):137–44.

    Article  CAS  Google Scholar 

  23. Mannstadt M, et al. Efficacy and safety of recombinant human parathyroid hormone (1-84) in hypoparathyroidism (REPLACE): a double-blind, placebo-controlled, randomised, phase 3 study. Lancet Diabetes Endocrinol. 2013;1(4):275–83.

    Article  CAS  Google Scholar 

  24. Sikjaer T, et al. The effect of adding PTH(1-84) to conventional treatment of hypoparathyroidism: a randomized, placebo-controlled study. J Bone Miner Res. 2011;26(10):2358–70.

    Article  CAS  Google Scholar 

  25. Hadker N, et al. Understanding the burden of illness associated with hypoparathyroidism reported among patients in the PARADOX study. Endocr Pract. 2014;20(7):671–9.

    Article  Google Scholar 

  26. Astor MC, et al. Epidemiology and health-related quality of life in hypoparathyroidism in Norway. J Clin Endocrinol Metab. 2016;101(8):3045–53.

    Article  CAS  Google Scholar 

  27. Buttner M, Musholt TJ, Singer S. Quality of life in patients with hypoparathyroidism receiving standard treatment: a systematic review. Endocrine. 2017.

    Google Scholar 

  28. Cusano NE, et al. PTH(1-84) is associated with improved quality of life in hypoparathyroidism through 5 years of therapy. J Clin Endocrinol Metab. 2014;99(10):3694–9.

    Article  CAS  Google Scholar 

  29. Sikjaer T, et al. Effects of PTH(1-84) therapy on muscle function and quality of life in hypoparathyroidism: results from a randomized controlled trial. Osteoporos Int. 2014;25(6):1717–26.

    Article  CAS  Google Scholar 

  30. Duan Y, De Luca V, Seeman E. Parathyroid hormone deficiency and excess: similar effects on trabecular bone but differing effects on cortical bone. J Clin Endocrinol Metab. 1999;84(2):718–22.

    Article  CAS  Google Scholar 

  31. Chen Q, et al. Effects of an excess and a deficiency of endogenous parathyroid hormone on volumetric bone mineral density and bone geometry determined by peripheral quantitative computed tomography in female subjects. J Clin Endocrinol Metab. 2003;88(10):4655–8.

    Article  CAS  Google Scholar 

  32. Cusano NE, et al. Noninvasive assessment of skeletal microstructure and estimated bone strength in hypoparathyroidism. J Bone Miner Res. 2016;31(2):308–16.

    Article  Google Scholar 

  33. Langdahl BL, et al. Bone histomorphometry in hypoparathyroid patients treated with vitamin D. Bone. 1996;18(2):103–8.

    Article  CAS  Google Scholar 

  34. Underbjerg L, et al. The epidemiology of nonsurgical hypoparathyroidism in Denmark: a nationwide case finding study. J Bone Miner Res. 2015;30(9):1738–44.

    Article  CAS  Google Scholar 

  35. Underbjerg L, et al. Postsurgical hypoparathyroidism – risk of fractures, psychiatric diseases, cancer, cataract, and infections. J Bone Miner Res. 2014;29(11):2504–10.

    Article  Google Scholar 

  36. Fujiyama K, et al. Attenuation of postmenopausal high turnover bone loss in patients with hypoparathyroidism. J Clin Endocrinol Metab. 1995;80(7):2135–8.

    CAS  PubMed  Google Scholar 

  37. Mendonca ML, et al. Increased vertebral morphometric fracture in patients with postsurgical hypoparathyroidism despite normal bone mineral density. BMC Endocr Disord. 2013;13:1.

    Article  CAS  Google Scholar 

  38. Silva BC, et al. Bone imaging in hypoparathyroidism. Osteoporos Int. 2017;28(2):463–71.

    Article  CAS  Google Scholar 

  39. Winer KK, et al. Long-term treatment of 12 children with chronic hypoparathyroidism: a randomized trial comparing synthetic human parathyroid hormone 1-34 versus calcitriol and calcium. J Clin Endocrinol Metab. 2010;95(6):2680–8.

    Article  CAS  Google Scholar 

  40. Rubin MR, et al. PTH(1-84) administration reverses abnormal bone-remodeling dynamics and structure in hypoparathyroidism. J Bone Miner Res. 2011;26(11):2727–36.

    Article  CAS  Google Scholar 

  41. Rubin MR, et al. Therapy of hypoparathyroidism with PTH(1-84): a prospective six year investigation of efficacy and safety. J Clin Endocrinol Metab. 2016;101(7):2742–50.

    Article  CAS  Google Scholar 

  42. Cipriani C, et al. Skeletal changes after restoration of the euparathyroid state in patients with hypoparathyroidism and primary hyperparathyroidism. Endocrine. 2017;55(2):591–8.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Susan Karam & Allison Hahr

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  1. Susan Karam
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  2. Allison Hahr
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Correspondence to Allison Hahr .

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Editors and Affiliations

  1. Division of Endocrinology and Metabolism, Loyola University Medical Center, Maywood, IL, USA

    Pauline M. Camacho

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Karam, S., Hahr, A. (2019). Hypoparathyroidism. In: Camacho, P. (eds) Metabolic Bone Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-03694-2_5

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  • DOI: https://doi.org/10.1007/978-3-030-03694-2_5

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