Diagnosing Hypoparathyroidism

Evaluation

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

Step 1: Physical Exam

The physical exam should include an assessment of neuromuscular irritability by testing for both Chvostek’s (A) and Trousseau’s (B) signs.1

Step 1: Physical Exam

The physical exam should include an assessment of neuromuscular irritability by testing for both Chvostek’s (A) and Trousseau’s (B) signs. 1

Electrocardiogram can reveal prolongation of the QT interval caused by hypocalcemia of hypoparathyroidism.1,2

Stethoscope Icon
Step 2: Lab Testing

Lab tests include1:

  • Serum total and ionized calcium
  • PTH concentration
  • Phosphate
  • Magnesium
  • BUN/creatinine
  • 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

Vial Icon
Step 3: Imaging

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

Step 3: Imaging Magnifying Glass Icon

Diagnosis

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

Image of Diagnosis Pathway

The Guidelines

New management guidelines for hypoparathyroidism were published in February 2016.

Brandi et al.

Management of hypoparathyroidism:
Summary statement and guidelines.

Scholar's Corner

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.