Review of clinical practice guidelines for hypoparathyroidism
https://doi.org/10.14341/serg12950
Abstract
Hypoparathyroidism is an endocrine disease characterized by reduced production of parathyroid hormone by the parathyroid glands or tissue resistance to its action. This is accompanied by disturbances in phosphorus-calcium metabolism.
The main cause of hypoparathyroidism is damage or removal of the parathyroid glands during surgery on the neck organs. Autoimmune hypoparathyroidism is the second most common form of the disease, which occurs, as a rule, within the autoimmune polyglandular syndrome type 1.
The development of chronic hypoparathyroidism of any etiology requires lifelong appointment of multicomponent therapy, as well as careful monitoring and an individual approach. In the absence of adequate dynamic monitoring, multiple complications develop from vital organs, in particular calcification of the urinary system, soft tissues and the brain; cardiovascular pathology; visual disturbances; muscle and bone diseases leading to decreased quality of life of patients.
Thus, timely diagnosis, rationally selected drug therapy and competent patient management will reduce the risks of complications, improve the prognosis, and reduce the frequency of hospitalizations and disability of patients with chronic hypoparathyroidism.
The article presents the main recommendations of the new project of clinical guidelines for patients with hypoparathyroidism, approved by the Ministry of Health of the Russian Federation in 2021. They include the algorithms of diagnosis, treatment and dynamic monitoring of hypoparathyroidism, as well as management of postsurgical hypocalcemia and medical care of and the disease during pregnancy.
About the Authors
E. V. KovalevaRussian Federation
Elena V. Kovaleva - MD, PhD.
Moscow
Competing Interests:
none
A. K. Eremkina
Russian Federation
Anna K. Eremkina - MD, PhD.
Moscow
Competing Interests:
none
I. S. Maganeva
Russian Federation
Irina S. Maganeva – MD.
Moscow
Competing Interests:
none
S. S. Mirnaya
Russian Federation
Svetlana S. Mirnaya - MD, PhD.
Moscow
Competing Interests:
none
I. V. Kim
Russian Federation
Ilya V. Kim.
Moscow
Competing Interests:
none
N. S. Kuznetzov
Russian Federation
Nikolay S. Kuznetzov - MD, PhD, Professor.
Moscow
Competing Interests:
none
E. N. Andreeva
Russian Federation
Elena N. Andreeva - MD, PhD, professor.
Moscow
Competing Interests:
none
T. L. Karonova
Russian Federation
Tatiana L. Karonova - MD, PhD.
Saint-Petersburg
Competing Interests:
none
I. V. Kryukova
Russian Federation
Irina V. Kryukova 0 MD, PhD.
Moscow
Competing Interests:
none
A. M. Mudunov
Russian Federation
Ali M. Mudunov - MD, PhD, Professor of the Russian Academy of Sciences.
Moscow; Lapino village
Competing Interests:
none
I. V. Sleptcov
Russian Federation
Ilya V. Sleptsov - MD, PhD, Prof.
Saint-Petersburg
Competing Interests:
none
G. A. Melnichenko
Russian Federation
Galina A. Melnichenko - MD, PhD, Prof, acad.
Moscow
Competing Interests:
none
N. G. Mokrysheva
Russian Federation
Natalia G. Mokrysheva - MD, PhD, Professor.
Moscow
Competing Interests:
none
References
1. Bilezikian JP. Hypoparathyroidism. J Clin Endocrinol Metab. 2020;105(6):1722-1736. https://doi.org/10.1210/clinem/dgaa113
2. Ковалева Е.В., Еремкина А.К., Крупинова Ю.А., и др. Обзор клинических рекомендаций по гипопаратиреозу // Проблемы эндокринологии. — 2021. — Т. 67. — №4. — С. 68-83. https://doi.org/10.14341/probl12800
3. Clarke BL, Brown EM, Collins MT, et al. Epidemiology and Diagnosis of Hypoparathyroidism. J Clin Endocrinol Metab. 2016;101(6):2284-2299. https://doi.org/10.1210/jc.2015-3908
4. Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L. The epidemiology of nonsurgical hypoparathyroidism in Denmark: A nationwide case finding study. J Bone Miner Res. 2015;30(9):1738–1744. https://doi.org/10.1002/jbmr.2501
5. Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L. Postsurgical hypoparathyroidism-Risk of fractures, Psychiatric Diseases, Cancer, Cataract, and Infections. J Bone Miner Res. 2014;29(1):2504–2510. https://doi.org/10.1002/jbmr.2273
6. Underbjerg L, Sikjaer T, Rejnmark L. Long-Term Complications in Patients With Hypoparathyroidism Evaluated by Biochemical Findings: A Case-Control Study. J Bone Miner Res. 2018;33(5):822–831. https://doi.org/10.1002/jbmr.3368
7. Cianferotti L. Classification of Hypoparathyroid Disorders. In: Frontiers of Hormone Research. 2019:127-138. https://doi.org/10.1159/000491043
8. Jindal H. Gracile Bone Dysplasia (GCLEB). In: Rezaei, N. (eds) Genetic Syndromes. Springer, Cham. 2024. https://doi.org/10.1007/978-3-319-66816-1_1504-1
9. Bilezikian JP, Khan AA, Brandi ML, et al. Evaluation and Management of Hypoparathyroidism Summary Statement and Guidelines from the Second International Workshop. J Bone Miner Res. 2022 Dec;37(12):2568–2585. https://doi.org/10.1002/jbmr.4691.
10. Shoback D. Hypoparathyroidism. N Engl J Med. 2008;359(4):391-403. https://doi.org/10.1056/NEJMcp0803050
11. Дедов И.И., Мельниченко Г.А., Мокрышева Н.Г. и др. Проект клинических рекомендаций по диагностике и лечению первичного гиперпаратиреоза у взрослых пациентов // Эндокринная хирургия. — 2022 — Т. 16 — № 4 — С. 5-54. https://doi.org/10.14341/serg12790
12. Hannan FM, Thakker RV. Investigating hypocalcaemia // BMJ. 2013;346(7911):1–4. https://doi.org/10.1136/bmj.f2213
13. Brandi ML, Bilezikian JP, Shoback D, et al. Management of Hypoparathyroidism: Summary Statement and Guidelines. J Clin Endocrinol Metab. 2016;101(6):2273-2283. https://doi.org/10.1210/jc.2015-3907
14. Maeda SS, Fortes EM, Oliveira UM, et. al. Hypoparathyroidism and pseudohypoparathyroidism. Arq Bras Endocrinol Metabol. 2006;50(4):664-73. https://doi.org/10.1590/s0004-27302006000400012
15. Bollerslev J, Rejnmark L, Marcocci C, et al. European Society of Endocrinology Clinical Guideline: Treatment of chronic hypoparathyroidism in adults. Eur J Endocrinol. 2015;173(2):G1-G20. https://doi.org/10.1530/EJE-15-0628
16. Khan AA, Koch CA, Van Uum S, et al. Standards of care for hypoparathyroidism in adults: A Canadian and international consensus. Eur J Endocrinol. 2019;180(3):1–22. https://doi.org/10.1530/EJE-18-0609
17. Shoback DM, Bilezikian JP, Costa AG, et al. Presentation of Hypoparathyroidism: Etiologies and Clinical Features. J Clin Endocrinol Metab. 2016;101(6):2300-2312. https://doi.org/10.1210/jc.2015-3909
18. Webster AC, Nagler EV, Morton RL, Masson P. Chronic Kidney Disease. Lancet. 2017. 25;389(10075):1238-1252. https://doi.org/10.1016/S0140-6736(16)32064-5
19. Pearce SH, Cheetham TD. Diagnosis and management of vitamin D deficiency. BMJ. 2010; 11;340:b5664. https://doi.org/10.1136/bmj.b5664
20. Agus ZS. Hypomagnesemia. J Am Soc Nephrol. 1999;10(7):1616-22. https://doi.org/10.1681/ASN.V1071616.
21. Kihara M, Yokomise H, Miyauchi A, Matsusaka K. Recovery of parathyroid function after total thyroidectomy. Surg Today. 2000;30(4):333-8. https://doi.org/10.1007/s005950050596
22. Boyce AM, Shawker TH, Hill SC. et. al. Ultrasound is superior to computed tomography for assessment of medullary nephrocalcinosis in hypoparathyroidism. J Clin Endocrinol Metab. 2013;98(3):989-94. https://doi.org/10.1210/jc.2012-2747
23. Saha S, Gantyala SP, Aggarwal S. et. al. Long-term outcome of cataract surgery in patients with idiopathic hypoparathyroidism and its relationship with their calcemic status. J Bone Miner Metab. 2017;35(4):405-411. https://doi.org/10.1007/s00774-016-0767-6
24. Ковалева Е.В. Хронический гипопаратиреоз: предикторы развития осложнений заболевания и персонализация ведения пациентов. — 2022. — 189 p.
25. Goswami R, Sharma R, Sreenivas V. et al. Prevalence and progression of basal ganglia calcification and its pathogenic mechanism in patients with idiopathic hypoparathyroidism. Clin Endocrinol (Oxf). 2012;77(2):200-6. https://doi.org/10.1111/j.1365-2265.2012.04353.x
26. Takamura Y, Miyauchi A, Yabuta T. et al. Attenuation of postmenopausal bone loss in patients with transient hypoparathyroidism after total thyroidectomy. World J Surg. 2013;37(12):2860-5. https://doi.org/10.1007/s00268-013-2207-2.
27. Silva BC, Rubin MR, Cusano NE, Bilezikian JP. Bone imaging in hypoparathyroidism. Osteoporos Int. 2017;28(2):463-471. https://doi.org/10.1007/s00198-016-3750-0
28. Rathod A, Bonny O, Guessous I. et al. Association of urinary calcium excretion with serum calcium and vitamin D levels. Clin J Am Soc Nephrol. 2015;10(3):452-62. https://doi.org/10.2215/CJN.12511213
29. Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L. Cardiovascular and renal complications to postsurgical hypoparathyroidism: a Danish nationwide controlled historic follow-up study. J Bone Miner Res. 2013;28(11):2277-85. https://doi.org/10.1002/jbmr.1979
30. Mitchell DM, Regan S, Cooley MR. et al. Long-term follow-up of patients with hypoparathyroidism. J Clin Endocrinol Metab. 2012;97(12):4507-14. https://doi.org/10.1210/jc.2012-1808.
31. Rodríguez-Ortiz ME, Canalejo A, Herencia C. et al. Magnesium modulates parathyroid hormone secretion and upregulates parathyroid receptor expression at moderately low calcium concentration. Nephrol Dial Transplant. 2014;29(2):282-9. https://doi.org/10.1093/ndt/gft400.
32. Bilezikian JP, Brandi ML, Cusano NE. et al. Management of Hypoparathyroidism: Present and Future. J Clin Endocrinol Metab. 2016;101(6):2313-24. https://doi.org/10.1210/jc.2015-3910.
33. Ковалева Е.В., Еремкина А.К., Мокрышева Н.Г. Суточный профиль как диагностический инструмент выявления гипо- и гиперкальциемии у пациентов с хроническим гипопаратиреозом. Серия клинических случаев // Ожирение и метаболизм. — 2021. — Т. 18. — №2. — С. 175–179. https://doi.org/10.14341/omet12729
34. Khan MI, Waguespack SG, Hu MI. Medical management of postsurgical hypoparathyroidism. Endocr Pract. 2011;17 Suppl 1:18-25. https://doi.org/10.4158/EP10302.RA
35. Davies M, Taylor CM, Hill LF, Stanbury SW. 1,25-dihydroxycholecalciferol in hypoparathyroidism. Lancet. 1977;1(8002):55-9. https://doi.org/10.1016/s0140-6736(77)91077-7.
36. Li DF, Gao YL, Liu HC. et al. Use of thiazide diuretics for the prevention of recurrent kidney calculi: a systematic review and meta-analysis. J Transl Med. 2020;18(1):106. https://doi.org/10.1186/s12967-020-02270-7
37. Porter RH, Cox BG, Heaney D. et al. Treatment of hypoparathyroid patients with chlorthalidone. N Engl J Med. 1978;298(11):577-81. https://doi.org/10.1056/NEJM197803162981101
38. Winer KK, Sinaii N, Peterson D. et al. Effects of once versus twice-daily parathyroid hormone 1-34 therapy in children with hypoparathyroidism. J Clin Endocrinol Metab. 2008;93(9):3389-95. https://doi.org/10.1210/jc.2007-2552
39. Bandeira LC, Rubin MR, Cusano NE, Bilezikian JP. Vitamin D and hypoparathyroidism. Frontiers of Hormone Research. 2018;(50):114-124. https://doi.org/10.1159/000486075
40. Клинические Рекомендации Российской Ассоциации Эндокринологов По Диагностике, Лечению И Профилактике Дефицита Витамина D У Взрослых // Проблемы эндокринологии. — 2016. — 62 — 4
41. Edafe O, Antakia R, Laskar N. et al. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg. 2014;101(4):307-20. https://doi.org/10.1002/bjs.9384
42. Cui Q, Li Z, Kong D. et al. A prospective cohort study of novel functional types of parathyroid glands in thyroidectomy: In situ preservation or auto-transplantation? Medicine (Baltimore). 2016;95(52):e5810. https://doi.org/10.1097/MD.0000000000005810
43. Oran E, Yetkin G, Mihmanlı M. et al. The risk of hypocalcemia in patients with parathyroid autotransplantation during thyroidectomy. Ulus Cerrahi Derg. 2015;32(1):6-10. https://doi.org/10.5152/UCD.2015.3013.
Supplementary files
|
1. Приложение А. Алгоритмы действий врача | |
Subject | ||
Type | Исследовательские инструменты | |
View
(715KB)
|
Indexing metadata ▾ |
|
2. Приложение Б. Алгоритм оценки степени компенсации хронического гипопаратиреоза и показания к проведению суточного профиля кальциемии | |
Subject | ||
Type | Исследовательские инструменты | |
View
(440KB)
|
Indexing metadata ▾ |
Review
For citations:
Kovaleva E.V., Eremkina A.K., Maganeva I.S., Mirnaya S.S., Kim I.V., Kuznetzov N.S., Andreeva E.N., Karonova T.L., Kryukova I.V., Mudunov A.M., Sleptcov I.V., Melnichenko G.A., Mokrysheva N.G. Review of clinical practice guidelines for hypoparathyroidism. Endocrine Surgery. 2024;18(2):4-22. (In Russ.) https://doi.org/10.14341/serg12950

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0).