Hypoparathyroidism -Quick revision chart
Metabolic disorder in which hypocalcemia and hyperphosphatemia occur either due to a failure of the parathyroid glands to secrete sufficient amount of biologically active PTH or from an inability of PTH to appropriately induce a biological response
major regulator of calcium and phosphate metabolism Secreted primarily in response to low calcium PTH raises free calcium ( sensing via Calcium sensing receptor ) by ○ increasing reabsorption from kidneys ○ release of calcium from the skeleton ○ increasing calcium absorption from intestine by increasing the synthesis of calcitriol
Parathyroid gland injury due to surgery / inadvertent removal is the most common cause.
Autoimmune ( 2nd most common cause ) , genetic variants ( e,g DiGeorge synd ) , infiltrative ( e,g granulomatous disease , haemochromatosis ) , metastatic , radiation , mineral deposition , magnesium deficiency / excess or idiopathic
clinical presentation ( hypocalcemia ) inappropriately low PTH in presence of hypocalcemia
enquire about h/o thyroid , head & neck surgery , radiation family h/o hypocalcemia check for Chvostek & Trousseau’s sign presence of other autoimmune conditions any condition predisposing to hypomagnesemia further testing can include ○ total corrected calcium corrected for albumin ○ PTH , phosphorus , magnesium , Us/Es and Vit D , LFT ○ 24 hr urinary calcium.
patient with chronic HypoPT may have lower QoL , muscle complaints as fatigue , weakness , more anxiety and tendency to depression increased risk of renal complications such as renal stones , renal insufficiency and higher risk of needing dialysis higher risk of seizures ectopic calcification in kidneys and brain.
One of the few endocrine illnesses in which the hormonal deficiency is not treated by the substitution of the hormone itself
- Hans SK, Levine SN. Hypoparathyroidism. [Updated 2021 Jul 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441899/
- Bilezikian, John P et al. “Hypoparathyroidism in the adult: epidemiology, diagnosis, pathophysiology, target-organ involvement, treatment, and challenges for future research.” Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research vol. 26,10 (2011): 2317-37. doi:10.1002/jbmr.483
- David, K., Moyson, C., Vanderschueren, D., & Decallonne, B. (2019). Long-term complications in patients with chronic hypoparathyroidism: a cross-sectional study, European Journal of Endocrinology, 180(1), 71-78. Retrieved Jan 23, 2022, from https://eje.bioscientifica.com/view/journals/eje/180/1/EJE-18-0580.xml
- Hakami Y, Khan A. Hypoparathyroidism. Front Horm Res. 2019;51:109-126. doi: 10.1159/000491042. Epub 2018 Nov 19. PMID: 30641528. ( Abstract )