Skip to main content
SpringerLink
Log in

Efficacy and safety of long-term management of patients with chronic post-surgical hypoparathyroidism

  • Original Article
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

Purpose

To evaluate adherence to European Society of Endocrinology guidelines and risk of renal complications in patients with chronic post-operative hypoparathyroidism (PO-HypoPT) treated with calcium and activated vitamin D metabolites.

Methods

We evaluated 90 adult patients (68 females and 22 males) with chronic (3 years) PO-HypoPT. Total albumin-corrected (Alb-Ca) and ionized serum calcium, phosphate, creatinine, PTH, and 24-h urinary calcium were measured; renal ultrasound was also performed. Healthy hospital employers (n = 142) were used as control.

Results

Complete data were available in 82 patients. Twenty-eight (34.1%) met four targets (Alb-Ca, phosphate, calcium phosphate product and 24-h urinary calcium), 36 (43.9%) three, 17 (20.7%) two, and 1 (1.2%) one. Thirteen (14.4%) had Alb-Ca value below and 18 (20.0%) above the target range and 54.9% 24-h urinary calcium above the upper normal limit. Seven (7.7%) has increased serum phosphate and none an increased calcium phosphate product. Eleven (12.2%) patients had eGFR < 60 mL/min × 1.73 m2. Nephrolithiasis was present in 27 (30%) patients. Compared with the controls, patients had lower Alb-Ca (8.9 ± 0.5 vs. 9.5 ± 0.3 mg/dL, P 0.0001) and a higher rate of kidney stones, mostly asymptomatic [27/90 (30%) vs 7/142 (5%), P < 0.0001, odd ratio 8.2 (3.4–19.9)]. Fifty-seven patients had ≥ four serum Ca2+ determinations during follow-up. Forty (70.2) patients had values within the target range in > 50% of cases, 18 in > 75%, and only 2 in 100%. Two patients never had values in the target range.

Conclusions

Treatment of chronic PO-HypoPT with calcium and activated vitamin D metabolites is suboptimal and associated with an increased risk of renal complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Shoback D (2008) Clinical practice. Hypoparathyroidism. N Engl J Med 359(4):391–403. https://doi.org/10.1056/NEJMcp0803050 (359/4/391 [pii])

    Article  CAS  PubMed  Google Scholar 

  2. Clarke BL, Brown EM, Collins MT, Juppner H, Lakatos P, Levine MA, Mannstadt MM, Bilezikian JP, Romanischen AF, Thakker RV (2016) Epidemiology and diagnosis of hypoparathyroidism. J Clin Endocrinol Metab 101(6):2284–2299. https://doi.org/10.1210/jc.2015-3908

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Shoback DM, Bilezikian JP, Costa AG, Dempster D, Dralle H, Khan AA, Peacock M, Raffaelli M, Silva BC, Thakker RV, Vokes T, Bouillon R (2016) Presentation of hypoparathyroidism: etiologies and clinical features. J Clin Endocrinol Metab 101(6):2300–2312. https://doi.org/10.1210/jc.2015-3909

    Article  CAS  PubMed  Google Scholar 

  4. Rosato L, Avenia N, Bernante P, De Palma M, Gulino G, Nasi PG, Pelizzo MR, Pezzullo L (2004) Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg 28(3):271–276. https://doi.org/10.1007/s00268-003-6903-1

    Article  PubMed  Google Scholar 

  5. Lorente-Poch L, Sancho JJ, Ruiz S, Sitges-Serra A (2015) Importance of in situ preservation of parathyroid glands during total thyroidectomy. Br J Surg 102(4):359–367. https://doi.org/10.1002/bjs.9676

    Article  CAS  PubMed  Google Scholar 

  6. Bollerslev J, Rejnmark L, Marcocci C, Shoback DM, Sitges-Serra A, van Biesen W, Dekkers OM, European Society of E (2015) European Society of Endocrinology clinical guideline: treatment of chronic hypoparathyroidism in adults. Eur J Endocrinol 173(2):G1–20. https://doi.org/10.1530/EJE-15-0628 (173/2/G1 [pii])

    Article  CAS  PubMed  Google Scholar 

  7. Brandi ML, Bilezikian JP, Shoback D, Bouillon R, Clarke BL, Thakker RV, Khan AA, Potts JT Jr (2016) Management of hypoparathyroidism: summary statement and guidelines. J Clin Endocrinol Metab 101(6):2273–2283. https://doi.org/10.1210/jc.2015-3907

    Article  CAS  PubMed  Google Scholar 

  8. Mitchell DM, Regan S, Cooley MR, Lauter KB, Vrla MC, Becker CB, Burnett-Bowie SA, Mannstadt M (2012) Long-term follow-up of patients with hypoparathyroidism. J Clin Endocrinol Metab 97(12):4507–4514. https://doi.org/10.1210/jc.2012-1808 (jc.2012-1808 [pii])

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L (2013) Cardiovascular and renal complications to postsurgical hypoparathyroidism: a Danish nationwide controlled historic follow-up study. J Bone Miner Res 28(11):2277–2285. https://doi.org/10.1002/jbmr.1979

    Article  PubMed  Google Scholar 

  10. Levey AS, Inker LA (2017) Assessment of glomerular filtration rate in health and disease: a state of the art review. Clin Pharmacol Ther 102(3):405–419. https://doi.org/10.1002/cpt.729

    Article  CAS  PubMed  Google Scholar 

  11. Arlt W, Fremerey C, Callies F, Reincke M, Schneider P, Timmermann W, Allolio B (2002) Well-being, mood and calcium homeostasis in patients with hypoparathyroidism receiving standard treatment with calcium and vitamin D. Eur J Endocrinol 146(2):215–222 (146215 [pii])

    Article  CAS  Google Scholar 

  12. Rubin MR, Dempster DW, Zhou H, Shane E, Nickolas T, Sliney J Jr, Silverberg SJ, Bilezikian JP (2008) Dynamic and structural properties of the skeleton in hypoparathyroidism. J Bone Miner Res 23(12):2018–2024. https://doi.org/10.1359/jbmr.080803

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Croppi E, Ferraro PM, Taddei L, Gambaro G, Group GEAFS (2012) Prevalence of renal stones in an Italian urban population: a general practice-based study. Urol Res 40(5):517–522. https://doi.org/10.1007/s00240-012-0477-z

    Article  PubMed  Google Scholar 

  14. Rubin MR, Cusano NE, Fan WW, Delgado Y, Zhang C, Costa AG, Cremers S, Dworakowski E, Bilezikian JP (2016) Therapy of hypoparathyroidism with PTH(1-84): a prospective six year investigation of efficacy and safety. J Clin Endocrinol Metab 101(7):2742–2750. https://doi.org/10.1210/jc.2015-4135

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors gratefully thank Dr. Giovanni Guglielmi and Dr. Irene Donato (U.O. Medicina Preventiva, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy) for their collaboration in the evaluation of the control subjects.

Author information

Author notes

  1. A. Meola and E. Vignali contributed equally to the study.

Authors and Affiliations

  1. Department of Clinical and Internal Medicine, University of Pisa, Via Paradisa 2, 56127, Pisa, Italy

    A. Meola, E. Vignali, A. Matrone, F. Cetani & C. Marcocci

Authors
  1. A. Meola
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Vignali
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Matrone
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. F. Cetani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Marcocci
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Marcocci.

Ethics declarations

Conflict of interest

Claudio Marcocci has received honorary and travel Grants from Shire. The other authors have no conflict of interest.

Ethical approval

The authors confirm that this retrospective work was performed in compliance with Ethical Standards and according to Institutional Review Board standards.

Informed consent

Informed consent was obtained from all participants.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Meola, A., Vignali, E., Matrone, A. et al. Efficacy and safety of long-term management of patients with chronic post-surgical hypoparathyroidism. J Endocrinol Invest 41, 1221–1226 (2018). https://doi.org/10.1007/s40618-018-0857-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40618-018-0857-5

Keywords

Search

Navigation