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Standards of Care for Hypoparathyroidism in Adults: A Canadian and international consensus

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  • Aliya Aziz Khan, A Khan, Medicine, Divisions of Endocrinology and Metabolism and Geriatric Medicine, McMaster University , Oakville, Canada.
  • ,
  • Christian Koch
  • Stanislaus Hendrikus Maria Van Uum, S Van Uum, Medicine, University of Western Ontario, London, N6A 4V2, Canada.
  • ,
  • Jean Patrice Baillargeon, J Baillargeon, Medicine, Universite de Sherbrooke Faculte de medecine et des sciences de la sante, Sherbrooke, Canada.
  • ,
  • Jens Bollerslev, J Bollerslev, Section of Specialized Endocrinology, Oslo University Hospital, Oslo, 0027, Norway.
  • ,
  • Maria Luisa Brandi, M Brandi, Department of Surgery and Translational Medicine, University of Florence, Florence, 50139, Italy.
  • ,
  • Claudio Marcocci, University of Pisa
  • ,
  • Lars Rejnmark
  • Rene Rizzoli, R Rizzoli, Division of Bone Diseases, University Hospitals and Faculty of Medicine of Geneva, Geneva, 1211, Switzerland.
  • ,
  • M Zakarea Shrayyef, M Shrayyef, Medicine, University of Toronto, Toronto, Canada.
  • ,
  • Rajesh V Thakker, R Thakker, Nuffield Department of Clinical Medicine, University of Oxford, Academic Endocrine Unit, Oxford, OX3 7LJ, United Kingdom of Great Britain and Northern Ireland.
  • ,
  • Bulent O Yildiz, B Yildiz, Dept of Internal Medicine, Endocrinology and Metabolism Unit, Hacettepe University School of Medicine, Ankara, 06100, Turkey.
  • ,
  • Bart Clarke, B Clarke, Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA, Rochester, United States.

Purpose: To provide practice recommendations for the diagnosis and management of hypoparathyroidism in adults. Methods: Key questions pertaining to the diagnosis and management of hypoparathyroidism were addressed following a literature review. We searched PubMed, MEDLINE, EMBASE and Cochrane databases from January 2000 to March 2018 using keywords 'hypoparathyroidism, diagnosis, treatment, calcium, PTH, calcidiol, calcitriol, hydrochlorothiazide and pregnancy'. Only English language papers involving humans were included. We excluded letters, reviews and editorials. The quality of evidence was evaluated based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. These standards of care for hypoparathyroidism have been endorsed by the Canadian Society of Endocrinology and Metabolism. Results: Hypoparathyroidism is a rare disease characterized by hypocalcemia, hyperphosphatemia and a low or inappropriately normal serum parathyroid hormone level (PTH). The majority of cases are post-surgical (75%) with nonsurgical causes accounting for the remaining 25% of cases. A careful review is required to determine the etiology of the hypoparathyroidism in individuals with nonsurgical disea se. Hypoparathyroidism is associated with significant morbidity and poor quality of life. Treatment requires close monitoring as well as patient education. Conventional therapy with calcium supplements and active vitamin D analogs i s effective in improving serum calcium as well as in controlling the symptoms of hypocalcemia. PTH replacement is of value in lowering the doses of calcium and active vitamin D analogs required and may be of value in lowering long-term complications of hypoparathyroidism. This manuscript addresses acute and chronic management of hypoparathyroidism in adults. Main conclusions: Hypoparathyroidism requires careful evaluation and pharmacologic intervention in order to improve serum calcium and control the symptoms of hypocalcemia. Frequen t laboratory monitoring of the biochemical profile and patient education is essential to achieving optimal control of serum calcium.

Original languageEnglish
JournalEuropean Journal of Endocrinology. Supplement
Volume180
Issue3
Pages (from-to)P1-P22
Number of pages22
ISSN0804-4635
DOIs
Publication statusPublished - Mar 2019

    Research areas

  • 1-34 REPLACEMENT THERAPY, BONE METABOLISM, CALCIUM-SENSING RECEPTOR, CONGENITAL HYPOPARATHYROIDISM, FOLLOW-UP, HUMAN PARATHYROID-HORMONE, HUMAN-PREGNANCY, LONG-TERM TREATMENT, QUALITY-OF-LIFE, VITAMIN-D

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