A patient history should include a review for a history of thyroid, parathyroid, or other neck surgery, and any relevant family history of hypocalcemia or related genetic disorders.1
Electrocardiogram can reveal prolongation of the QT interval caused by hypocalcemia of hypoparathyroidism.1,2
Lab tests include1:
- Serum total and ionized calcium
- PTH concentration
- 25-hydroxyvitamin D [25(OH) vitamin D] levels
Once a diagnosis is made, the initial evaluation should include a 24-hour urinary calcium excretion, estimated or calculated glomerular filtration rate (GFR), and a biochemical stone risk profile, if the clinical situation warrants it.1
Initial imaging studies should include dual-energy x-ray absorptiometry to assess bone mineral density, skull x-ray for basal ganglia and other intracerebral calcifications, and abdominal imaging for renal stones and calcifications.1 In hypoparathyroidism, bone turnover is decreased and bone mineral density is increased.3
Diagnosis of hypoparathyroidism is established by concurrent measurement of albumin-corrected or ionized serum calcium below the lower limits of the normal range and low or undetectable levels of PTH as determined either by a second- or third-generation immunoassay on at least 2 occasions separated by at least 2 weeks.1
New management guidelines for hypoparathyroidism were published in February 2016.
Brandi et al.
Management of hypoparathyroidism:Summary statement and guidelines.
PUBLISHED LITERATURE ON HYPOPARATHYROIDISM ETIOLOGY AND BURDEN OF DISEASE
Bilezikian et al.
Hypoparathyroidism in the adult: Epidemiology, diagnosis, pathophysiology, target-organ involvement, treatment, and challenges for future research.
Brandi et al.
Management of hypoparathyroidism: Summary statement and guidelines.
Shoback et al.
Clinical Practice: Hypoparathyroidism.
Brandi ML, et al. J Clin Endocrinol Metab. 2016;101(6):2273-2283.
Monis EL, Mannstadt M. Ann Endocrinol (Paris). 2015;76(2):84-88.
Rubin MR, Bilezikian JP. Arq Bras Endocrinol Metabol. 2010;54(2):20-226.