Abstract
Hypoparathyroidism is a relatively rare endocrine disease characterised by either null or inappropriately low secretion of parathyroid hormone (PTH) for serum calcium levels. The other main laboratory findings include hypocalcaemia, inappropriately normal or high urine calcium excretion and hyperphosphataemia with low urine phosphate excretion. The management of hypoparathyroidism should be tailored to each individual case, which makes it a demanding undertaking in everyday clinical practice. In this review, we sought to focus on the diagnostic approach of hypoparathyroidism and the therapeutic challenges of the disease from a clinical perspective. Conventional treatment with vitamin D analogues and calcium salts is no longer the only available treatment, since replacement treatment with PTH(1-84) has recently been approved for the disease. However, the optimal treatment schedule is yet to be defined.
Similar content being viewed by others
References
Cooper MS, Gittoes NJ (2008) Diagnosis and management of hypocalcaemia. BMJ 336:1298–1302
Abate EG, Clarke BL (2016) Review of hypoparathyroidism. Front Endocrinol (Lausanne) 7:172
Bilezikian JP, Khan A, Potts JT Jr, Brandi ML, Clarke BL, Shoback D et al (2011) Hypoparathyroidism in the adult: epidemiology, diagnosis, pathophysiology, target-organ involvement, treatment, and challenges for future research. J Bone Miner Res 26:2317–2337
Powers J, Joy K, Ruscio A, Lagast H (2013) Prevalence and incidence of hypoparathyroidism in the United States using a large claims database. J Bone Miner Res 28:2570–2576
Mitchell DM, Regan S, Cooley MR, Lauter KB, Vrla MC, Becker CB et al (2012) Long-term follow-up of patients with hypoparathyroidism. J Clin Endocrinol Metab 97:4507–4514
Garrahy A, Murphy MS, Sheahan P (2016) Impact of postoperative magnesium levels on early hypocalcemia and permanent hypoparathyroidism after thyroidectomy. Head Neck 38:613–619
Nakamoto JM, Sandstrom AT, Brickman AS, Christenson RA, Van Dop C (1998) Pseudohypoparathyroidism type Ia from maternal but not paternal transmission of a Gsalpha gene mutation. Am J Med Genet 77:261–267
Stieler K, Schnabel D, Atugoda S, Sterry W, Blume-Peytavi U (2011) Albright hereditary osteodystrophy. Pediatr Dermatol 28:135–137
Elli FM, deSanctis L, Ceoloni B, Barbieri AM, Bordogna P, Beck-Peccoz P, Spada A, Mantovani G (2013) Pseudohypoparathyroidism type Ia and pseudo-pseudohypoparathyroidism: the growing spectrum of GNAS inactivating mutations. Hum Mutat 34:411–416
Shoback D (2008) Clinical practice: hypoparathyroidism. N Engl J Med 359:391–403
Shoback DM, Bilezikian JP, Costa AG, Dempster D, Dralle H, Khan AA et al (2016) Presentation of hypoparathyroidism: etiologies and clinical features. J Clin Endocrinol Metab 101:2300–2312
Rastogi R, Beauchamp NJ, Ladenson PW (2003) Calcification of the basal ganglia in chronic hypoparathyroidism. J Clin Endocrinol Metab 88:1476–1477
Preusser M, Kitzwoegerer M, Budka H, Brugger S (2007) Bilateral striopallidodentate calcification (Fahr's syndrome) and multiple system atrophy in a patient with longstanding hypoparathyroidism. Neuropathology 27:453–456
Cakerri L, Husi G, Minxuri D, Roko E, Vyshka G (2014) Primary hypoparathyroidism presenting with heart failure and ventricular fibrillation. Oxf Med Case Reports 4:77–79
Rubin MR, Dempster DW, Kohler T, Stauber M, Zhou H, Shane E et al (2010) Three dimensional cancellous bone structure in hypoparathyroidism. Bone 46:190–195
Rubin MR, Bilezikian JP (2010) Hypoparathyroidism: clinical features, skeletal microstructure and parathyroid hormone replacement. Arq Bras Endocrinol Metabol 54:220–226
Cusano NE, Nishiyama KK, Zhang C, Rubin MR, Boutroy S, McMahon DJ et al (2016) Noninvasive assessment of skeletal microstructure and estimated bone strength in hypoparathyroidism. J Bone Miner Res 31:308–316
Christen P, Ito K, Muller R, Rubin MR, Dempster DW, Bilezikian JP et al (2012) Patient-specific bone modelling and remodelling simulation of hypoparathyroidism based on human iliac crest biopsies. J Biomech 45:2411–2416
Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L (2015) The epidemiology of nonsurgical hypoparathyroidism in Denmark: a nationwide case finding study. J Bone Miner Res 30:1738–1744
Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L (2014) Postsurgical hypoparathyroidism—risk of fractures, psychiatric diseases, cancer, cataract, and infections. J Bone Miner Res 29:2504–2510
Mendonca ML, Pereira FA, Nogueira-Barbosa MH, Monsignore LM, Teixeira SR, Watanabe PC et al (2013) Increased vertebral morphometric fracture in patients with postsurgical hypoparathyroidism despite normal bone mineral density. BMC Endocr Disord 13:1
Buttner M, Musholt TJ, Singer S (2017) Quality of life in patients with hypoparathyroidism receiving standard treatment: a systematic review. Endocrine 58:14–20
Sikjaer T, Moser E, Rolighed L, Underbjerg L, Bislev LS, Mosekilde L, Rejnmark L (2016) Concurrent hypoparathyroidism is associated with impaired physical function and quality of life in hypothyroidism. J Bone Miner Res 31:1440–1448
Rejnmark L (2018) Quality of life in hypoparathyroidism. Endocrine 59:237–238
Winer KK, Zhang B, Shrader JA, Peterson D, Smith M, Albert PS et al (2012) Synthetic human parathyroid hormone 1-34 replacement therapy: a randomized crossover trial comparing pump versus injections in the treatment of chronic hypoparathyroidism. J Clin Endocrinol Metab 97:391–399
Thakker RVBF, Jόppner H (2016) Regulation of calcium homeostasis and genetic disorders that affect calcium metabolism. Elsevier, Philadelphia
Hannan FM, Thakker RV (2013) Investigating hypocalcaemia. BMJ 346:f2213
Akin L, Kurtoglu S, Yildiz A, Akin MA, Kendirici M (2010) Vitamin D deficiency rickets mimicking pseudohypoparathyroidism. J Clin Res Pediatr Endocrinol 2:173–175
Brandi ML, Bilezikian JP, Shoback D, Bouillon R, Clarke BL, Thakker RV et al (2016) Management of hypoparathyroidism: summary statement and guidelines. J Clin Endocrinol Metab 101:2273–2283
Bilezikian JP, Brandi ML, Cusano NE, Mannstadt M, Rejnmark L, Rizzoli R, Rubin MR, Winer KK, Liberman UA, Potts JT Jr (2016) Management of hypoparathyroidism: present and future. J Clin Endocrinol Metab 101:2313–2324
Bollerslev J, Rejnmark L, Marcocci C, Shoback DM, Sitges-Serra A, van Biesen W et al (2015) Treatment of chronic hypoparathyroidism in adults. Eur J Endocrinol 173:G1–G20
Stack BC Jr, Bimston DN, Bodenner DL, Brett EM, Dralle H, Orloff LA et al (2015) American Association of Clinical Endocrinologists and American College of Endocrinology Disease state clinical review: postoperative hypoparathyroidism—definitions and management. Endocr Pract 21:674–685
Streeten EA, Mohtasebi Y, Konig M, Davidoff L, Ryan K (2017) Hypoparathyroidism: less severe hypocalcemia with treatment with vitamin D2 compared with calcitriol. J Clin Endocrinol Metab 102:1505–1510
Spaia S (2011) Phosphate binders: Sevelamer in the prevention and treatment of hyperphosphataemia in chronic renal failure. Hippokratia 15:22–26
Winer KK, Yanovski JA, Cutler GB Jr (1996) Synthetic human parathyroid hormone 1-34 vs calcitriol and calcium in the treatment of hypoparathyroidism. JAMA 276:631–636
Shah M, Bancos I, Thompson GB, Richards ML, Kasperbauer JL, Clarke BL et al (2015) Teriparatide therapy and reduced postoperative hospitalization for postsurgical hypoparathyroidism. JAMA Otolaryngol Head Neck Surg 141:822–827
Palermo A, Santonati A, Tabacco G, Bosco D, Spada A, Pedone C et al (2018) PTH(1-34) for surgical hypoparathyroidism: a 2 year prospective, open-label investigation of efficacy and quality of life. J Clin Endocrinol Metab 103:271–280
Winer KK, Sinaii N, Peterson D, Sainz B Jr, Cutler GB Jr (2008) Effects of once versus twice-daily parathyroid hormone 1-34 therapy in children with hypoparathyroidism. J Clin Endocrinol Metab 93:3389–3395
Winer KK, Sinaii N, Reynolds J, Peterson D, Dowdy K, Cutler GB Jr (2010) Long-term treatment of 12 children with chronic hypoparathyroidism: a randomized trial comparing synthetic human parathyroid hormone 1-34 versus calcitriol and calcium. J Clin Endocrinol Metab 95:2680–2688
Winer KK, Fulton KA, Albert PS, Cutler GB Jr (2014) Effects of pump versus twice-daily injection delivery of synthetic parathyroid hormone 1-34 in children with severe congenital hypoparathyroidism. J Pediatr 165:556–563 e551
Clarke BL, Kay Berg J, Fox J, Cyran JA, Lagast H (2014) Pharmacokinetics and pharmacodynamics of subcutaneous recombinant parathyroid hormone (1-84) in patients with hypoparathyroidism: an open-label, single-dose, phase I study. Clin Ther 36:722–736
Rubin MR, Cusano NE, Fan WW, Delgado Y, Zhang C, Costa AG et al (2016) Therapy of hypoparathyroidism with PTH(1-84): a prospective six year investigation of efficacy and safety. J Clin Endocrinol Metab 101:2742–2750
Mannstadt M, Clarke BL, Vokes T, Brandi ML, Ranganath L, Fraser WD et al (2013) Efficacy and safety of recombinant human parathyroid hormone (1-84) in hypoparathyroidism (REPLACE): a double-blind, placebo-controlled, randomised, phase 3 study. Lancet Diabetes Endocrinol 1:275–283
Clarke BL, Vokes TJ, Bilezikian JP, Shoback DM, Lagast H, Mannstadt M (2017) Effects of parathyroid hormone rhPTH(1-84) on phosphate homeostasis and vitamin D metabolism in hypoparathyroidism: REPLACE phase 3 study. Endocrine 55:273–282
Misof BM, Roschger P, Dempster DW, Zhou H, Bilezikian JP, Klaushofer K et al (2016) PTH(1-84) administration in hypoparathyroidism transiently reduces bone matrix mineralization. J Bone Miner Res 31:180–189
Lakatos P, Bajnok L, Lagast H, Valkusz Z (2016) An open-label extension study of parathyroid hormone Rhpth(1-84) in adults with hypoparathyroidism. Endocr Pract 22:523–532
Bilezikian JP, Clarke BL, Mannstadt M, Rothman J, Vokes T, Lee HM et al (2017) Safety and efficacy of recombinant human parathyroid hormone in adults with hypoparathyroidism randomly assigned to receive fixed 25-mug or 50-mug daily doses. Clin Ther 39:2096–2102
Cusano NE, Rubin MR, McMahon DJ, Irani D, Anderson L, Levy E et al (2014) PTH(1-84) is associated with improved quality of life in hypoparathyroidism through 5 years of therapy. J Clin Endocrinol Metab 99:3694–3699
Sikjaer T, Rolighed L, Hess A, Fuglsang-Frederiksen A, Mosekilde L, Rejnmark L (2014) Effects of PTH(1-84) therapy on muscle function and quality of life in hypoparathyroidism: results from a randomized controlled trial. Osteoporos Int 25:1717–1726
Santonati A, Palermo A, Maddaloni E, Bosco D, Spada A, Grimaldi F et al (2015) PTH(1-34) for surgical hypoparathyroidism: a prospective, open-label investigation of efficacy and quality of life. J Clin Endocrinol Metab 100:3590–3597
Theman TA, Collins MT, Dempster DW, Zhou H, Reynolds JC, Brahim JS et al (2009) PTH(1-34) replacement therapy in a child with hypoparathyroidism caused by a sporadic calcium receptor mutation. J Bone Miner Res 24:964–973
Cusano NE, Rubin MR, McMahon DJ, Zhang C, Ives R, Tulley A et al (2013) Therapy of hypoparathyroidism with PTH(1-84): a prospective four-year investigation of efficacy and safety. J Clin Endocrinol Metab 98:137–144
Clarke BV, Vokes TJ, Bilezikian JP (2017) Recombinant human parathyroid hormone (rhPTH[1-84], parathyroid hormone rDNA) improves hypercalciuria in patients with hypoparathyroidism: 3-year analysis from RACE study. Endocr Abstr 49:GP47
Levine MB, Sundberg JP, Clarke, BL. (2015) Long-Term effects of recombinant human parathyroid hormone, rhPTH(1-84), on bone remodeling in patients with hypoparathyroidism: 3-year data from the open-label RACE study. In ECTS and IBMS joined meeting. Rotterdam
Cipriani C, Irani D, Bilezikian JP (2012) Safety of osteoanabolic therapy: a decade of experience. J Bone Miner Res 27:2419–2428
Andrews EB, Gilsenan AW, Midkiff K, Sherrill B, Wu Y, Mann BH et al (2012) The US postmarketing surveillance study of adult osteosarcoma and teriparatide: study design and findings from the first 7 years. J Bone Miner Res 27:2429–2437
Mirabello L, Troisi RJ, Savage SA (2009) Osteosarcoma incidence and survival rates from 1973 to 2004: data from the Surveillance, Epidemiology, and End Results Program. Cancer 115:1531–1543
Vahle JL, Sato M, Long GG, Young JK, Francis PC, Engelhardt JA et al (2002) Skeletal changes in rats given daily subcutaneous injections of recombinant human parathyroid hormone (1-34) for 2 years and relevance to human safety. Toxicol Pathol 30:312–321
Jolette J, Wilker CE, Smith SY, Doyle N, Hardisty JF, Metcalfe AJ et al (2006) Defining a noncarcinogenic dose of recombinant human parathyroid hormone 1-84 in a 2-year study in Fischer 344 rats. Toxicol Pathol 34:929–940
Bilezikian JP, Drezner M, Kream B, Stern P, Clemens T, Elderkin A et al (2011) Lawrence G. Raisz November 13, 1925-August 25, 2010. J Bone Miner Res 26:903–911
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors have nothing to declare regarding this paper.
Additional information
This article is a product of the 5th ENDO COMBO, during which a lecture under the same title was presented as part of the course by the senior author.
Rights and permissions
About this article
Cite this article
Triantafyllou, E., Yavropoulou, M.P., Anastasilakis, A.D. et al. Hypoparathyroidism: is it that easy to treat?. Hormones 18, 55–63 (2019). https://doi.org/10.1007/s42000-018-0032-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s42000-018-0032-6