1
|
de Souza Sartori JF, Dos Santos ML, Stollmeier A, Julio Cerci R, Aguiar Moreira C, Zeghbi Cochenski Borba V. Coronary calcium score in patients with post-surgical hypoparathyroidism. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2024; 68:e230053. [PMID: 38578437 PMCID: PMC11081047 DOI: 10.20945/2359-4292-2023-0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/02/2023] [Indexed: 04/06/2024]
Abstract
Objective This study aimed to evaluate the cardiovascular risk of patients with post-surgical hypoparathyroidism through coronary calcium score (CACS) evaluation andcardiovascular risk calculators. Subjects and methods Patients with post-surgical hypoparathyroidism (HG = 29) were compared to a control group (CG = 29), matched by sex and age. Demographic and clinical data were captured by a questionnaire or patient files. Both groups performed a thoracic-computed tomography to evaluate the CACS and the cardiovascular risk was calculated by two risk calculators. Results In the HG, the supplementation of calcium varied between 500 to 2,000 mg/day and the mean calcitriol was 0.5 ± 0.29 mcg/day. The mean serum calcium and phosphorus were 8.32 ± 0.68 and 4.92 ± 0.87 mg/dL, respectively, and in the range recommended for hypoparathyroidism. The Brazilian Society of Cardiology's risk calculator showed a difference among groups, with no patient in the HG with low risk, but the CACS was similar. A positive CACS in the HG was associated with obesity and high BMI but not with calcium and/or vitamin D supplementation. Conclusion In conclusion, patients with hypoparathyroidism did not show increased CACS, and it was not related to supplementation.
Collapse
Affiliation(s)
| | | | - Aline Stollmeier
- Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brasil
| | | | - Carolina Aguiar Moreira
- Departamento de Medicina, Divisão de Endocrinologia, Universidade Federal do Paraná, Curitiba, PR, Brasil
| | | |
Collapse
|
2
|
Soares CSP, Koga KH, Moriguchi SM, Terra SA, Tagliarini JV, de Vasconcelos Affonso PHD, da Silva Pechutti M, da Silva Mazeto GMF. Development of a tool to calculate the probability of hypocalcemia after total thyroidectomy: a prospective study. Langenbecks Arch Surg 2024; 409:33. [PMID: 38195723 DOI: 10.1007/s00423-024-03229-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/03/2024] [Indexed: 01/11/2024]
Abstract
PURPOSE This study aimed to evaluate the ability of the percentage of decrease in serum PTH level in the first 8 h after total thyroidectomy (TT) to predict hypocalcemia requiring Ca supplementation and develop a tool to predict it. METHODS 97 patients who underwent TT with measurement of preoperative parathyroid hormone (PTH) levels were prospectively evaluated 1 and 8 h after TT; postoperative magnesium (Mg2PO) and phosphorus levels were evaluated on the 2nd day after surgery. The percentage of decrease in PTH level 1 h (%dPTH1h) and 8 h (%dPTH8h) postoperatively and predictors of hypocalcemia requiring Ca supplementation were evaluated and an equation was developed to predict this outcome. RESULTS %dPTH1h (p = 0.002), %dPTH8h (p = 0.001) and (Mg2PO) (p < 0.01) were isolated predictors of postoperative hypocalcemia requiring Ca supplementation. The data obtained led to the development of two tools to predict this complication. CONCLUSIONS The percentage of decrease in PTH level 1 h and 8 h postoperatively and the magnesium level on the 2nd day after surgery were predictors of more severe hypocalcemia, and an auxiliary tool for predicting this complication was developed.
Collapse
Affiliation(s)
- Carlos Segundo Paiva Soares
- Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - Unesp, Botucatu, SP, 18618970, Brazil.
- Department of Surgical Specialties and Anesthesiology, Av. Professor Mário Rubens Guimarães Montenegro, s/n, UNESP Campus de Botucatu, Botucatu, SP, CEP 18618-687, Brazil.
| | - Katia Hiromoto Koga
- Nuclear Medicine Department, Botucatu Medical School, Sao Paulo State University - Unesp, Botucatu, SP, 18618970, Brazil
| | - Sonia Marta Moriguchi
- Nuclear Medicine Department, Botucatu Medical School, Sao Paulo State University - Unesp, Botucatu, SP, 18618970, Brazil
| | - Simone Antunes Terra
- Pathology Department, Botucatu Medical School, Sao Paulo State University - Unesp, Botucatu, SP, 18618970, Brazil
| | - José Vicente Tagliarini
- Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - Unesp, Botucatu, SP, 18618970, Brazil
| | | | - Monise da Silva Pechutti
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University - Unesp, Botucatu, SP, 18618970, Brazil
| | | |
Collapse
|
3
|
Sakane EN, Vieira MCC, Vieira GMM, Maeda SS. Treatment options in hypoparathyroidism. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:651-657. [PMID: 36382754 PMCID: PMC10118816 DOI: 10.20945/2359-3997000000554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hypoparathyroidism remains the single endocrine deficiency disease that is not habitually treated with the missing hormone. In this article, we aim to provide a review of the conventional approach and the novel therapies as well as an overview of the perspectives on the treatment of this rare condition. We conducted a literature review on the conventional therapy using vitamin D analogs and calcium salts, indications for thiazide diuretics and phosphorus binders, PTH analogs history and usage, and the drugs that are currently being tested in clinical trials. Conventional treatment involves calcium salts and vitamin D analogs. Thiazide diuretics can be used to reduce hypercalciuria in some cases. A low-phosphate diet is recommended, and phosphate binders are rarely needed. During pregnancy, a careful approach is necessary. The use of PTH analogs is a new approach despite the limitation of high cost. Studies have included modified PTH molecules, calcilytics, microencapsulation of human parathyroid cells, and allotransplantation.
Collapse
|
4
|
Silva BC. Skeletal and nonskeletal consequences of hypoparathyroidism. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:642-650. [PMID: 36382753 PMCID: PMC10118831 DOI: 10.20945/2359-3997000000553] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Hypoparathyroidism, despite the conventional therapy with calcium and active vitamin D, can lead to skeletal and nonskeletal abnormalities. Chronic hypoparathyroidism is associated with a significant reduction in bone remodeling, increases in areal and volumetric bone density, and improvement in trabecular microarchitecture and in trabecular bone score. Regardless of these advantages in bone mass and microarchitecture, recent data suggest an increased vertebral fracture risk in patients with nonsurgical hypoparathyroidism. Moreover, chronic hypoparathyroidism can lead to abnormalities in multiple organ systems, including the neurological, cardiovascular, renal, neuropsychiatric, ocular, and immune systems. Nephrocalcinosis, nephrolithiasis, and renal insufficiency, as well as decreased quality of life and cataracts, are common in patients with hypoparathyroidism. An increased incidence of hospitalization due to infections and a greater risk of cardiovascular diseases are observed in patients with hypoparathyroidism, particularly in those with nonsurgical disease. All these abnormalities may be because of the disease itself or complications of therapy. We herein reviewed the skeletal and nonskeletal consequences of hypoparathyroidism in patients conventionally managed with calcium and active vitamin D.
Collapse
|
5
|
Spinelli C, Ghionzoli M, Bertocchini A, Sanna B, Plessi C, Strambi S, De Napoli L, Frustaci G, Materazzi G, Antonelli A, Morganti R, Gennari F, Inserra A, Bisogno G, Gamba P, Ferrari A, Massimino M. Factors associated with postoperative hypocalcemia following thyroidectomy in childhood. Pediatr Blood Cancer 2022; 69:e29576. [PMID: 35129296 DOI: 10.1002/pbc.29576] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 12/19/2021] [Accepted: 12/27/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Postoperative hypocalcemia is a frequent complication after thyroidectomy. Hypoparathyroidism may develop as transient (TtHP), with normalization within six months from surgery, or permanent (PtHP) if the patient requires replacement therapy. We analyzed factors associated with the development of postoperative hypoparathyroidism and in detail PtHP following thyroid surgery in a pediatric population. PROCEDURE A retrospective multicenter study analyzing 326 patients was carried out. We recorded gender, age, tumor size, thyroiditis, extrathyroidal extension, lymph node dissection (central/lateral compartment, unilateral/bilateral), parathyroid autotransplantation, and histology. Additionally, calcium levels were acquired postoperatively. RESULTS We analyzed pediatric patients ≤18 years who underwent thyroidectomy clustered into age groups (≤15 or > 15). Patients' mean follow-up was 5.8 years (1-11 years). Postoperative hypoparathyroidism occurred in 36 (11.0%): 20 cases (6.13%) developed PtHP. Postoperative hypoparathyroidism was more frequent in younger patients (P = 0.014), in larger tumors (P < 0.001), in case of extrathyroidal extension (P = 0.037), and in central compartment (P = 0.020) and bilateral lymph node dissection (P = 0.030). PtHP was more frequent in older patients (P = 0.014), in case of thyroiditis (P < 0.001), and extrathyroidal extension (P < 0.001). Concerning the first postoperative calcium level measurement, in the postoperative hypoparathyroidism group, we registered a 8.17 mg/dL value with 14% pre/postoperative decrease (ΔCa ), whereas in PtHP patient group calcium level was 7.91 mg/dL with 16.7% ΔCa . CONCLUSIONS The risk of postoperative hypoparathyroidism is related to younger age, tumor size, central compartment and bilateral lymph node dissection, extrathyroidal extension, and decrease in postoperative calcium levels. The risk of PtHP is related to older age, thyroiditis, extrathyroidal extension, and decrease in postoperative calcium levels.
Collapse
Affiliation(s)
- Claudio Spinelli
- Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, Pisa, Italy
| | - Marco Ghionzoli
- Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, Pisa, Italy
| | - Alessia Bertocchini
- Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, Pisa, Italy
| | - Beatrice Sanna
- Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, Pisa, Italy
| | - Carlotta Plessi
- Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, Pisa, Italy
| | - Silvia Strambi
- Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, Pisa, Italy
| | - Luigi De Napoli
- Department of Surgical Pathology, Endocrine Surgery Division, University of Pisa, Pisa, Italy
| | - Gianluca Frustaci
- Department of Surgical Pathology, Endocrine Surgery Division, University of Pisa, Pisa, Italy
| | - Gabriele Materazzi
- Department of Surgical Pathology, Endocrine Surgery Division, University of Pisa, Pisa, Italy
| | - Alessandro Antonelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Riccardo Morganti
- Division of statistical support to clinical studies, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fabrizio Gennari
- Division of Pediatric Surgery, "Regina Margherita Hospital,", Turin, Italy
| | - Alessandro Inserra
- General Pediatric and Thoracic Surgery, Bambino Gesù Children's Hospital-Research Institute, Rome, Italy
| | - Gianni Bisogno
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Piergiorgio Gamba
- Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Andrea Ferrari
- Department of Pediatrics, National Cancer Institute, Milan, Italy
| | - Maura Massimino
- Department of Pediatrics, National Cancer Institute, Milan, Italy
| |
Collapse
|
6
|
Casale M, Baldini MI, Del Monte P, Gigante A, Grandone A, Origa R, Poggi M, Gadda F, Lai R, Marchetti M, Forni GL. Good Clinical Practice of the Italian Society of Thalassemia and Haemoglobinopathies (SITE) for the Management of Endocrine Complications in Patients with Haemoglobinopathies. J Clin Med 2022; 11:jcm11071826. [PMID: 35407442 PMCID: PMC8999784 DOI: 10.3390/jcm11071826] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 02/01/2023] Open
Abstract
Background: The treatment of endocrinopathies in haemoglobinopathies is a continually expanding research area; therefore, recommendations supporting the appropriateness of treatments are a pressing need for the medical community. Methods: The Management Committee of SITE selected and gathered a multidisciplinary and multi-professional team, including experts in haemoglobinopathies and experts in endocrinopathies, who have been flanked by experts with methodological and organizational expertise, in order to formulate recommendations based on the available scientific evidence integrated by personal clinical experience. The project followed the systematic approach for the production of clinical practice guidelines according to the methodology suggested by the National Center for Clinical Excellence, Quality and Safety of Care (CNEC). Results: Out of 14 topics, 100 clinical questions were addressed, and 206 recommendations were elaborated on. The strength of recommendations, panel agreement, a short general description of the topic, and the interpretation of evidence were reported. Conclusions: Good Practice Recommendations are the final outcome of translational research and allow one to transfer to the daily clinical practice of endocrine complications in haemoglobinopathies.
Collapse
Affiliation(s)
- Maddalena Casale
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy;
- Correspondence: ; Tel.: +39-081-566-5432
| | - Marina Itala Baldini
- Centro Malattie Rare, UOC Medicina Interna, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.I.B.); (F.G.)
| | | | - Antonia Gigante
- Società Italiana Talassemie d Emoglobinopatie (SITE), Fondazione per la Ricerca sulle Anemie ed Emoglobinopatie in Italia—For Anemia, 16124 Genoa, Italy;
| | - Anna Grandone
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy;
| | - Raffaella Origa
- SSD Talassemia, Ospedale Pediatrico Microcitemico Cao, Università di Cagliari, 09124 Cagliari, Italy; (R.O.); (R.L.)
| | - Maurizio Poggi
- UOC Endocrinologia, Azienda Ospedaliera Sant’Andrea, 00189 Rome, Italy;
| | - Franco Gadda
- Centro Malattie Rare, UOC Medicina Interna, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.I.B.); (F.G.)
| | - Rosalba Lai
- SSD Talassemia, Ospedale Pediatrico Microcitemico Cao, Università di Cagliari, 09124 Cagliari, Italy; (R.O.); (R.L.)
| | - Monia Marchetti
- Day Service Ematologia, SOC Oncologia, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy;
| | - Gian Luca Forni
- Centro Emoglobinopatie e Anemie Congenite, Ospedali Galliera, 16128 Genoa, Italy;
| |
Collapse
|
7
|
Silva BC, Bilezikian JP. Skeletal abnormalities in Hypoparathyroidism and in Primary Hyperparathyroidism. Rev Endocr Metab Disord 2021; 22:789-802. [PMID: 33200346 DOI: 10.1007/s11154-020-09614-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 12/22/2022]
Abstract
Both hypoparathyroidism (HypoPT), as well as its pathological counterpart, primary hyperparathyroidism (PHPT), can lead to skeletal abnormalities. Chronic deficiency of PTH in patients with HypoPT is associated with a profound reduction in bone remodeling, with consequent increases in bone density, and abnormalities in microarchitecture and bone strength. It is still not clear whether there is an increase in fracture risk in HypoPT. While standard therapy with calcium supplements and active vitamin D does not restore bone homeostasis, treatment of HypoPT with PTH appears to correct some of those abnormalities. In PHPT, the continuous exposure to high levels of PTH causes an increase in bone remodeling, in which bone resorption prevails. In the symptomatic form of PHPT, patients can present with fragility fractures, and/or the classical radiological features of osteitis fibrosa cystica. However, even in mild PHPT, catabolic skeletal actions of PTH are evident through reduced BMD, deterioration of bone microarchitecture and increased risk of fragility fractures. Successful parathyroidectomy improves skeletal abnormalities. Medical treatment, such as bisphosphonates and denosumab, can also increase bone density in patients with PHPT who do not undergo surgery. This article reviews skeletal involvement in HypoPT and in PHPT, as assessed by bone remodeling, DXA, trabecular bone score, and quantitative computed tomography, as well as data on bone strength and fracture risk. The effects of PTH replacement on the skeleton in subjects with HypoPT, and the outcome of parathyroidectomy in patients with PHPT, are also reviewed here.
Collapse
Affiliation(s)
- Barbara C Silva
- Department of Medicine, Centro Universitario de Belo Horizonte - UNI BH, Belo Horizonte, Brazil
- Endocrinology Unit, Felicio Rocho Hospital, Belo Horizonte, Brazil
- Endocrinology Unit, Santa Casa Hospital, Belo Horizonte, Brazil
| | - John P Bilezikian
- Metabolic Bone Diseases Unit, Division of Endocrinology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, 630 W. 168th Street, PH 8E: 105G, New York, NY, 10032, USA.
| |
Collapse
|
8
|
Kovaleva EV, Eremkina AK, Krupinova JA, Mirnaya SS, Kim IV, Kuznetzov NS, Andreeva EN, Karonova TL, Kryukova IV, Mudunov AM, Sleptcov IV, Melnichenko GA, Mokrysheva NG, Dedov II. [Review of clinical practice guidelines for hypoparathyroidism]. ACTA ACUST UNITED AC 2021; 67:68-83. [PMID: 34533015 DOI: 10.14341/probl12800] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 11/06/2022]
Abstract
Hypoparathyroidism is a rare disorder characterized by the absent or inappropriately decreased serum parathyroid hormone in the parathyroid glands, which is accompanied by impaired calcium-phosphorus metabolism.The main etiology of hypoparathyroidism remains damage or removal of the parathyroid glands during neck surgery. In view of the incidence of thyroid cancer, primary hyperparathyroidism and other pathologies of the neck organs, which radical treatment can lead to the parathyroid gland impairment, an increased number of patients with hypoparathyroidism is expected. Autoimmune hypoparathyroidism is the second most common form of the disease, usually occurring as part of type 1 autoimmune polyglandular syndrome. Autoimmune hypoparathyroidism usually occurs in childhood and is characterized by a severe course of the disease, especially in the case of concomitant malabsorption syndrome.Chronic hypoparathyroidism of any etiology requires lifelong multicomponent therapy, as well as careful monitoring and an individual approach to choose the optimal treatment strategy. In the absence of adequate follow-up, the risks of long-term complications significantly increase, particularly in the renal, cardiovascular systems; in the soft tissues and in the brain, it could lead to visual disturbances; pathology of the musculoskeletal system with a decreased bone remodeling and a potential risk of fractures, as well as to the neurocognitive disorders and an impaired health-related quality of life.Timely diagnosis, rational medical therapy and management strategy may reduce the risks of short-term and long-term complications, frequency of hospitalizations and disability of patients, as well as improve the prognosis.This review covers the main issues of Russian guidelines for the management of chronic hypoparathyroidism, approved in 2021, including laboratory and instrumental evaluation, treatment approaches and follow-up. This guidelines also include the recommendations for special groups of patients: with acute hypocalcemia, hypoparathyroidism during pregnancy.
Collapse
Affiliation(s)
| | | | | | | | - I V Kim
- Endocrinology Research Center
| | | | | | - T L Karonova
- National Medical Research Center. V. A. Almazova
| | - I V Kryukova
- Moscow Regional Research Clinical Institute. M.F. Vladimirskogo
| | - A M Mudunov
- National Medical Research Center of Oncology named after V.I. N.N. Blokhin
| | - I V Sleptcov
- Clinic of high medical technologies. N.I. Pirogov St. Petersburg State University
| | | | | | | |
Collapse
|
9
|
Saraiva M, Chaves AC, Assunção G, Saraiva J, Carvalho R. Continuous Teriparatide Treatment in Chronic Hypoparathyroidism: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931739. [PMID: 34389697 PMCID: PMC8370137 DOI: 10.12659/ajcr.931739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Patient: Female, 29-year-old
Final Diagnosis: Chronic hypoparathyroidism
Symptoms: Muscle cramps • numbness • tingling in fingers
Medication: —
Clinical Procedure: —
Specialty: Endocrinology and Metabolic
Collapse
Affiliation(s)
- Miguel Saraiva
- Division of Endocrinology, Diabetes, and Metabolism, Porto University Hospital Center, Porto, Portugal
| | - Ana Catarina Chaves
- Division of Endocrinology, Diabetes, and Metabolism, Hospital Center of Tâmega and Sousa (CHTS), Penafiel, Portugal
| | - Guilherme Assunção
- Division of Endocrinology, Diabetes, and Metabolism, Porto University Hospital Center, Porto, Portugal
| | - Joana Saraiva
- Division of Endocrinology, Diabetes, and Metabolism, Coimbra Hospital and University Center, Coimbra, Portugal
| | - Rui Carvalho
- Division of Endocrinology, Diabetes, and Metabolism, Porto University Hospital Center, Porto, Portugal
| |
Collapse
|
10
|
Zanchetta MB, Robbiani D, Oliveri B, Giacoia E, Frigeri A, Kallsbrum S, Salerni H, Lucas S, Diaz A, Perez B, Pieroni L, Arce Lange MA, Tormo S, Kitaigrodsky A, Galich AM. Hipopara-Red, Real Life Experience in 322 Patients With Hypoparathyroidism. J Endocr Soc 2021; 5:bvaa181. [PMID: 33409439 PMCID: PMC7774093 DOI: 10.1210/jendso/bvaa181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Indexed: 12/24/2022] Open
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 1st step in improving our medical management of this disease in the future.
Collapse
Affiliation(s)
- María Belén Zanchetta
- IDIM, Instituto de Investigaciones Metabólicas, Buenos Aires, Argentina.,Facultad de Medicina, Cátedra de Osteología, Universidad del Salvador, Buenos Aires, Argentina
| | - Damián Robbiani
- IDIM, Instituto de Investigaciones Metabólicas, Buenos Aires, Argentina.,Facultad de Medicina, Cátedra de Osteología, Universidad del Salvador, Buenos Aires, Argentina
| | | | - Evangelina Giacoia
- Servicio de Endocrinología y Metabolismo, Hospital Posadas, Provincia de Buenos Aires, Argentina
| | - Adriana Frigeri
- Unidad de Endocrinología, Hospital Dr T. Alvarez, Buenos Aires, Argentina
| | - Silvia Kallsbrum
- Servicio de Endocrinología, Hospital Carlos G Durand, Buenos Aires, Argentina
| | - Helena Salerni
- Servicio de Endocrinología, Hospital Carlos G Durand, Buenos Aires, Argentina
| | - Sabrina Lucas
- Sección Osteopatías Médicas, División Endocrinología de Clínicas José de San Martin-UBA, Buenos Aires, Argentina
| | - Adriana Diaz
- Sección Osteopatías Médicas, División Endocrinología de Clínicas José de San Martin-UBA, Buenos Aires, Argentina
| | - Betiana Perez
- Servicio de Endocrinología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Luisina Pieroni
- Unidad de Endocrinología, Hospital Dr T. Alvarez, Buenos Aires, Argentina
| | | | - Silvina Tormo
- Servicio de Endocrinología y Metabolismo, Hospital Posadas, Provincia de Buenos Aires, Argentina
| | - Ariela Kitaigrodsky
- Servicio de Endocrinología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ana María Galich
- Servicio de Endocrinología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
11
|
Abstract
PURPOSE OF REVIEW Hypoparathyroidism is a rare endocrine disorder characterized by low or insufficient parathyroid hormone (PTH) concentrations leading to hypocalcemia, hyperphosphatemia, and markedly reduced bone turnover. Despite being a rare disease, hypoparathyroidism has a profound impact on affected patients. RECENT FINDINGS Recent epidemiologic surveys demonstrate a prevalence of between 5.3 and 40/100 000, confirming the orphan status of this disease. There is a female predominance, and anterior neck surgery is the most common etiology. Recent studies have better elucidated the chronic manifestations of the disease, impacting quality of life and multiple organ systems including the renal, cardiovascular, and skeletal systems. There are now data on longer term use of parathyroid hormone (PTH) and PTH analogs. SUMMARY This review focuses on recent contributions to the literature on the prevalence and epidemiology of the disease, risk of chronic manifestations, and treatment with PTH(1-34) and rhPTH(1-84). Further research is needed to determine the pathophysiology of complications in hypoparathyroidism and whether interventions can decrease future risk of these complications. In addition, further data are needed with regards to more physiologic dosing regimens and long-term treatment with PTH and PTH analogs.
Collapse
|
12
|
Sakane EN, Vieira MCC, Lazaretti-Castro M, Maeda SS. Predictors of Poor Bone Microarchitecture Assessed by Trabecular Bone Score in Postsurgical Hypoparathyroidism. J Clin Endocrinol Metab 2019; 104:5795-5803. [PMID: 31305931 DOI: 10.1210/jc.2019-00698] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/09/2019] [Indexed: 12/17/2022]
Abstract
CONTEXT The effects of PTH deprivation on bone are still unclear. Our objective was to report the characteristics of patients with postsurgical hypoparathyroidism (PsH) at a specialized outpatient service and correlate their trabecular bone score (TBS) values to clinical, densitometric, and laboratory findings. A secondary objective was to evaluate the fracture rates and look for associations between these events and the collected data. RESULTS Eighty-two patients were enrolled, of whom 70 (85.4%) were female and 17 (20.7%) had type 2 diabetes mellitus (T2DM). The median body mass index (BMI) was 27.7 kg/m2 and the median age was 59 years. Of 68 dual-energy x-ray absorptiometry (DXA) scans obtained, osteopenia and osteoporosis were present in 32.4% and 2.9%, respectively. In all, 62 lumbar scans were analyzed by using TBS. The mean TBS value (±SD) was 1.386 ± 0.140, and 32.2% of the results were <1.310. TBS values correlated negatively with BMI (mainly > 30 kg/m2), age (mainly > 60 years), and glycemia, whereas abnormal TBS correlated with osteopenia, T2DM, low-impact fracture, and menopause. Six female patients had low-impact fractures, which were associated with a lower TBS (1.178 ± 0.065 vs. 1.404 ± 0.130 in the group without fractures; P < 0.001), older age, higher BMI, impaired renal function, abnormal glycemia, and osteopenia. CONCLUSION The findings suggests that known risk factors for bone loss compromise the bone microarchitecture of individuals with PsH, regardless of DXA results. Menopausal women with PsH and older patients with PsH who have osteopenia, a higher BMI, or T2DM may be candidates for a more detailed assessment by using, for example, TBS.
Collapse
Affiliation(s)
- Eliane Naomi Sakane
- Department of Medicine, Endocrinology Unit, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Marise Lazaretti-Castro
- Department of Medicine, Endocrinology Unit, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sergio Setsuo Maeda
- Department of Medicine, Endocrinology Unit, Universidade Federal de São Paulo, São Paulo, Brazil
| |
Collapse
|
13
|
Weiss RV, Hohl A, Athayde A, Pardini D, Gomes L, de Oliveira M, Meirelles R, Clapauch R, Spritzer PM. Testosterone therapy for women with low sexual desire: a position statement from the Brazilian Society of Endocrinology and Metabolism. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2019; 63:190-198. [PMID: 31340240 PMCID: PMC10522198 DOI: 10.20945/2359-3997000000152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 04/22/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To summarize current evidence regarding testosterone treatment for women with low sexual desire. MATERIALS AND METHODS The Female Endocrinology and Andrology Department of the Brazilian Society of Endocrinology and Metabolism invited nine experts to review the physiology of testosterone secretion and the use, misuse, and side effects of exogenous testosterone therapy in women, based on the available literature and guidelines and statements from international societies. RESULTS Low sexual desire is a common complaint in clinical practice, especially in postmenopausal women, and may negatively interfere with quality of life. Testosterone seems to exert a positive effect on sexual desire in women with sexual dysfunction, despite a small magnitude of effect, a lack of long-term safety data, and insufficient evidence to make a broad recommendation for testosterone therapy. Furthermore, there are currently no testosterone formulations approved for women by the relevant regulatory agencies in the United States, Brazil, and most other countries, and testosterone formulations approved for men are not recommended for use by women. CONCLUSION Therefore, testosterone therapy might be considered if other strategies fail, but the risks and benefits must be discussed with the patient before prescription. Arch Endocrinol Metab. 2019;63(3):190-8.
Collapse
Affiliation(s)
- Rita V. Weiss
- Pontifícia Universidade Católica do Rio de JaneiroInstituto Estadual de Diabetes e Endocrinologia Luiz CapriglionePontifícia Universidade Católica do Rio de JaneiroEscola Médica de Pós-Graduação em EndocrinologiaRio de JaneiroRJBrasilInstituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, Pontifícia Universidade Católica do Rio de Janeiro, Escola Médica de Pós-Graduação em Endocrinologia (IEDE-PUC/RJ), Rio de Janeiro, RJ, Brasil
| | - Alexandre Hohl
- Universidade Federal de Santa CatarinaDepartamento de Medicina InternaHospital UniversitárioUniversidade Federal de Santa CatarinaFlorianópolisSCBrasilServiço de Endocrinologia e Metabolismo, Departamento de Medicina Interna, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brasil
| | - Amanda Athayde
- Pontifícia Universidade Católica do Rio de JaneiroInstituto Estadual de Diabetes e Endocrinologia Luiz CapriglionePontifícia Universidade Católica do Rio de JaneiroEscola Médica de Pós-Graduação em EndocrinologiaRio de JaneiroRJBrasilInstituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, Pontifícia Universidade Católica do Rio de Janeiro, Escola Médica de Pós-Graduação em Endocrinologia (IEDE-PUC/RJ), Rio de Janeiro, RJ, Brasil
- Universidade Federal do Rio de JaneiroUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilUniversidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Dolores Pardini
- Universidade Federal de São PauloUniversidade Federal de São PauloSão PauloSPBrasilDisciplina de Endocrinologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil
| | - Larissa Gomes
- Universidade de São PauloFaculdade de MedicinaHospital de ClínicasUniversidade de São PauloSão PauloSPBrasilDisciplina de Endocrinologia, Faculdade de Medicina, Hospital de Clínicas, Universidade de São Paulo (USP), São Paulo, SP, Brasil
| | - Monica de Oliveira
- Instituto de Medicina Integral Professor Fernando FigueiraInstituto de Medicina Integral Professor Fernando FigueiraRecifePEBrasilInstituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brasil
| | - Ricardo Meirelles
- Pontifícia Universidade Católica do Rio de JaneiroInstituto Estadual de Diabetes e Endocrinologia Luiz CapriglionePontifícia Universidade Católica do Rio de JaneiroEscola Médica de Pós-Graduação em EndocrinologiaRio de JaneiroRJBrasilInstituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, Pontifícia Universidade Católica do Rio de Janeiro, Escola Médica de Pós-Graduação em Endocrinologia (IEDE-PUC/RJ), Rio de Janeiro, RJ, Brasil
| | - Ruth Clapauch
- Departamento de Fisiologia Endócrina e FisiologiaLaboratório de Pesquisas Clínicas e Experimentais em Biologia VascularRio de JaneiroRJBrasilDepartamento de Fisiologia Endócrina e Fisiologia e Laboratório de Pesquisas Clínicas e Experimentais em Biologia Vascular (BIOVASC), Rio de Janeiro, RJ, Brasil
| | - Poli Mara Spritzer
- Universidade Federal do Rio Grande do SulHospital de Clínicas de Porto AlegreDepartamento de FisiologiaUniversidade Federal do Rio Grande do SulPorto AlegreRSBrasilUnidade de Endocrinologia Ginecológica, Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre e Departamento de Fisiologia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
| |
Collapse
|
14
|
Montenegro FLDM, Brescia MDG, Lourenço DM, Arap SS, d'Alessandro AF, de Britto e Silva Filho G, Toledo SPDA. Could the Less-Than Subtotal Parathyroidectomy Be an Option for Treating Young Patients With Multiple Endocrine Neoplasia Type 1-Related Hyperparathyroidism? Front Endocrinol (Lausanne) 2019; 10:123. [PMID: 30899245 PMCID: PMC6417394 DOI: 10.3389/fendo.2019.00123] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 02/11/2019] [Indexed: 12/13/2022] Open
Abstract
Background: The surgical treatment of primary hyperparathyroidism (HPT) in patients with multiple endocrine neoplasia type 1 (MEN1) has evolved due the concern of permanent hypoparathyroidism. As the diagnosis has increased, the extent of operation has decreased. Most MEN1 patients requiring parathyroidectomy are younger than 50 years and they pose a difficult balance to achieve between persistent HPT and life-long hypoparathyroidism. The aim of the present study is to review our experience with a large series of patients with MEN1-related HPT (HPT/MEN1) treated at a single institution in order to find clues to a better treatment decision in these younger cases. Method: Retrospective analysis of consecutive HPT/MEN1 cases treated at a single institution with different operations: total parathyroidectomy and immediate forearm autograft (TPTX-AG), subtotal (STPTX), unintentional less than subtotal (U-LSTPTX) and intentional less than subtotal parathyroidectomy (I-LSTPTX). Results: Considering 84 initial cases operated on since 2011 (TPTX-AG, 39; STPTX, 22, U-LSTPTX, 13, and I-LSTPTX, 10), the rates of hypoparathyroidism were 30.8% (U-LSTPTX), 28.2% (TPTX-AG), 13.6% (STPTX), and 0% (I-LSTPTX). Two-thirds of them (68%; 57/84) were young (<50 years) or asdolescents. MIBI scan was more sensitive to show parathyroid glands and bilateral disease. Considering the concordance of MIBI and ultrasound for the possibility of unilateral clearance, it would be suitable to 22.6% of the cases. Intra-operative parathormone showed a significant decay even after unilateral exploration, but longer follow up is necessary. Overall, there were seven (4%) adolescents in 161 cases treated from 1987 to 2018, three underwent TPTX-AG and four had U-LSTPTX. Five are euparathyroid, one had mild recurrence, and one required a reoperation after 8 years due to the residual gland. Conclusions: Young patients are the most frequent candidates to parathyroidectomy. Less extensive procedures may be planned only if carefully reviewed preoperative imaging studies suggest a localized disease. Patients and their relatives should be fully informed of the risks and benefits during consent process. Future research with larger cohorts and long-term results are necessary to clarify if less than I-LSPTX or unilateral clearance are really adequate in selected groups of patients with HPT/MEN1 presenting lower volume of disease detected by preoperative imaging studies.
Collapse
Affiliation(s)
- Fabio Luiz de Menezes Montenegro
- Parathyroid Unit- LIM-28, Laboratório de Cirurgia de Cabeça e Pescoço, Head and Neck Surgery, Department of Surgery, Hospital das Clinicas HCFMUSP, University of Sao Paulo School of Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- *Correspondence: Fabio Luiz de Menezes Montenegro
| | - Marilia D'Elboux Guimaraes Brescia
- Parathyroid Unit- LIM-28, Laboratório de Cirurgia de Cabeça e Pescoço, Head and Neck Surgery, Department of Surgery, Hospital das Clinicas HCFMUSP, University of Sao Paulo School of Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Delmar Muniz Lourenço
- Endocrine Genetics Unit (LIM-25), Endocrinology Division, Hospital das Clinicas, University of Sao Paulo School of Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Endocrine Oncology Division, Institute of Cancer of the State of Sao Paulo, University of Sao Paulo School of Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Sergio Samir Arap
- Parathyroid Unit- LIM-28, Laboratório de Cirurgia de Cabeça e Pescoço, Head and Neck Surgery, Department of Surgery, Hospital das Clinicas HCFMUSP, University of Sao Paulo School of Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Andre Fernandes d'Alessandro
- Parathyroid Unit- LIM-28, Laboratório de Cirurgia de Cabeça e Pescoço, Head and Neck Surgery, Department of Surgery, Hospital das Clinicas HCFMUSP, University of Sao Paulo School of Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Gilberto de Britto e Silva Filho
- Parathyroid Unit- LIM-28, Laboratório de Cirurgia de Cabeça e Pescoço, Head and Neck Surgery, Department of Surgery, Hospital das Clinicas HCFMUSP, University of Sao Paulo School of Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Sergio Pereira de Almeida Toledo
- Endocrine Genetics Unit (LIM-25), Endocrinology Division, Hospital das Clinicas, University of Sao Paulo School of Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|