Hipopara-Red, Real Life Experience in 322 Patients With Hypoparathyroidism

Abstract

Context: Hypoparathyroidism is a rare disease and, as such, its natural history, long-term complications, and correct clinical management remain unclear.

Objective: To describe the natural history and clinical characteristics of the disease.

Design and setting: To present a retrospective observational analysis from 7 specialized centers in Buenos Aires, Argentina.

Patients: Chronic hypoparathyroid patients followed-up between 1985 and December 2018.

Main outcome measures: Data on demographics, etiology, clinical complications, biochemical parameters, dual-energy x-ray absorptiometry (DXA) values, and treatment doses were collected.

Results: A total of 322 subjects with chronic hypoparathyroidism were included; 85.7% were female, the mean age was 55.2 ± 16.8 years, and the mean age at diagnosis was 43.8 ± 16.8 years. Prevalence of surgical hypoparathyroidism was 90.7%, with the most common causes being thyroid carcinoma and benign thyroid disease. A history of hypocalcemia requiring hospitalization was present in 25.7% of the whole group and in 4.3% of patients who had a history of seizures. Overall, 40.9% of our patients had reported at least 1 neuromuscular symptom. Renal insufficiency was present in 22.4% of our patients and was significantly associated with age (P < 0.0001). Hyperphosphatemia was present in 42% of patients. A history of severe hypocalcemia, paresthesias, tetany, ganglia calcifications, seizures, and cataracts was significantly higher in nonsurgical patients.

Conclusion: Although these patients were followed-up by experienced physicians, clinical management was heterogeneous and probably insufficient to assess all the potential complications of this chronic disease. Almost 70% of the study's group of patients met the experts' indications for considering the use of rhPTH 1-84. Being aware of this fact is the 1^st step in improving our medical management of this disease in the future.

Keywords: PTH; hyperphosphatemia; hypocalcemia; hypoparathyroidism.

Figure 1.

Etiology in 322 patients with hypoparathyroidism. Thyroid adenoma implies benign thyroid disease, including single adenoma, goiter, multinodular goiter, or Graves’ disease.