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

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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.

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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.

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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

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  1. A. Meola
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  2. E. Vignali
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  3. A. Matrone
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  4. F. Cetani
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Corresponding author

Correspondence to C. Marcocci.

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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.

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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

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

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