Managing Hypoparathyroidism

Conventional management of hypoparathyroidism involves dietary and oral calcium, active vitamin D or analogues, magnesium, thiazide diuretics, a low-salt diet, phosphate binders, and a low-phosphate diet1

6 Goals of Therapy

6 Goals of Therapy

THERAPEUTIC GOALS PROPOSED BY BOTH THE INTERNATIONAL AND EUROPEAN GUIDELINES INCLUDE THE FOLLOWING1,2

  • Prevent signs and symptoms of hypocalcemia
  • Maintain the serum calcium concentration slightly below normal (ie, no more than 0.5 mg/dL below normal) or in the low normal range
  • Maintain the calcium × phosphate product below 55 mg2/dL2 (4.4 mmol2/L2)
  • Avoid hypercalciuria
  • Avoid hypercalcemia
  • Avoid renal (nephrocalcinosis/nephrolithiasis) and other extraskeletal calcifications

THERAPEUTIC GOALS PROPOSED BY BOTH THE INTERNATIONAL AND EUROPEAN GUIDELINES INCLUDE THE FOLLOWING1,2

  • Prevent signs and symptoms of hypocalcemia
  • Maintain the serum calcium concentration slightly below normal (ie, no more than 0.5 mg/dL below normal) or in the low normal range
  • Maintain the calcium × phosphate product below 55 mg2/dL2 (4.4 mmol2/L2)
  • Avoid hypercalciuria
  • Avoid hypercalcemia
  • Avoid renal (nephrocalcinosis/nephrolithiasis) and other extraskeletal calcifications
Target Range on the Calcemia Spectrum

Monitoring

Monitoring guidelines for conventional therapy1:

  • Calcium, phosphate, magnesium, BUN/creatinine, and eGFR: yearly or more frequently if the clinical situation is appropriate
  • 24-hour urine collection for calcium and creatinine

As clinically indicated1:

  • Renal imaging (for nephrolithiasis/nephrocalcinosis)
  • Ophthalmological exam (cataracts)
  • Central nervous system imaging (basal ganglia and other sites of calcification)
  • Bone mineral density

Other Considerations

Management guidelines for determining when hypoparathyroidism may not be fully controlled1,2

  • Signs or symptoms of hypocalcemia are present
  • Serum calcium level is not in the correct range
  • Calcium × phosphate product is out of balance
  • Excessive calcium in urine
  • Renal or other extraskeletal calcification
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Management guidelines for determining when hypoparathyroidism may not be fully controlled1,2

  • Signs or symptoms of hypocalcemia are present
  • Serum calcium level is not in the correct range
  • Calcium × phosphate product is out of balance
  • Excessive calcium in urine
  • Renal or other extraskeletal calcification
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Scholar's Corner

PUBLISHED LITERATURE ON HYPOPARATHYROIDISM MANAGEMENT

Bollerslev et al; European Society of Endocrinology.
European Society of Endocrinology Clinical Guideline: Treatment of chronic hypoparathyroidism in adults.

Brandi et al.
Management of hypoparathyroidism: Summary statement and guidelines.

Brandi ML, et al. J Clin Endocrinol Metab. 2016;101(6):2273-2283.

Bollerslev J, et al; European Society of Endocrinology. Eur J Endocrinol. 2015;173(2):G1-G20.

Horwitz MJ, Stewart AF. J Clin Endocrinol Metab. 2008;93(9):3307-3309.

Quest Diagnostics. Test Center. Calcium Spectrophotometry: reference ranges. http://www.questdiagnostics.com/testcenter/TestDetail.action?ntc=303. Accessed July 28, 2016.