Follow-up in Chronic Hypoparathyroidism

  • Michael MannstadtEmail author
  • Deborah M. Mitchell


Patients with hypoparathyroidism are at risk of many complications, both from the disease itself as well as from adverse effects of currently available treatment regimens. Ongoing care with a provider familiar with the treatment of this disorder is critical in order to meet the complex needs of patients and to optimize their outcomes (see also Chap.  15). The overarching goals of follow-up care for hypoparathyroidism are to ensure that effective care is in place and that the manifestations of the disease are as well controlled as possible.


Hypoparathyroidism Hypocalcemia Nephrocalcinosis Imaging Cataracts Follow-up 


  1. 1.
    Shoback D (2008) Clinical practice. Hypoparathyroidism. N Engl J Med 359(4):391–403CrossRefPubMedGoogle Scholar
  2. 2.
    Newman DB, Fidahussein SS, Kashiwagi DT, Kennel KA, Kashani KB, Wang Z et al (2014) Reversible cardiac dysfunction associated with hypocalcemia: a systematic review and meta-analysis of individual patient data. Heart Fail Rev 19(2):199–205CrossRefPubMedGoogle Scholar
  3. 3.
    Chakrabarty AD (2013) Adult primary hypoparathyroidism: A rare presentation. Indian J Endocrinol Metab 17(Suppl 1):S201–2CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    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(12):4507–14CrossRefPubMedCentralPubMedGoogle Scholar
  5. 5.
    Mallette LE (1992) Case report: hypoparathyroidism with menses-associated hypocalcemia. Am J Med Sci 304(1):32–7CrossRefPubMedGoogle Scholar
  6. 6.
    Thys-Jacobs S, McMahon D, Bilezikian JP (2007) Cyclical changes in calcium metabolism across the menstrual cycle in women with premenstrual dysphoric disorder. J Clin Endocrinol Metab 92(8):2952–9CrossRefPubMedGoogle Scholar
  7. 7.
    Gauci C, Moranne O, Fouqueray B, de la Faille R, Maruani G, Haymann JP et al (2008) Pitfalls of measuring total blood calcium in patients with CKD. J Am Soc Nephrol 19(8):1592–8CrossRefPubMedCentralPubMedGoogle Scholar
  8. 8.
    Nordenstrom E, Katzman P, Bergenfelz A (2011) Biochemical diagnosis of primary hyperparathyroidism: analysis of the sensitivity of total and ionized calcium in combination with PTH. Clin Biochem 44(10–11):849–52CrossRefPubMedGoogle Scholar
  9. 9.
    Brickman AS, Coburn JW, Koppel MH, Peacock M, Massry SG (1971) The effect of hydrochlorothiazide administration on serum and urinary calcium in normal, hypoparathyroid and hyperparathyroid subjects. Studies on mechanisms. Isr J Med Sci 7(3):518–9PubMedGoogle Scholar
  10. 10.
    Lemann J Jr, Gray RW, Maierhofer WJ, Cheung HS (1985) Hydrochlorothiazide inhibits bone resorption in men despite experimentally elevated serum 1,25-dihydroxyvitamin D concentrations. Kidney Int 28(6):951–8CrossRefPubMedGoogle Scholar
  11. 11.
    Frassetto LA, Nash E, Morris RC Jr, Sebastian A (2000) Comparative effects of potassium chloride and bicarbonate on thiazide-induced reduction in urinary calcium excretion. Kidney Int 58(2):748–52CrossRefPubMedGoogle Scholar
  12. 12.
    Macfadyen IJ, Nordin BE, Smith DA, Wayne DJ, Rae SL (1965) Effect of variation in dietary calcium on plasma concentration and urinary excretion of calcium. Br Med J 1(5428):161–4CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Arlt W, Fremerey C, Callies F, Reincke M, Schneider P, Timmermann W et al (2002) Well-being, mood and calcium homeostasis in patients with hypoparathyroidism receiving standard treatment with calcium and vitamin D. Eur J Endocrinol 146(2):215–22CrossRefPubMedGoogle Scholar
  14. 14.
    Peacock M, Robertson WG, Nordin BE (1969) Relation between serum and urinary calcium with particular reference to parathyroid activity. Lancet 1(7591):384–6CrossRefPubMedGoogle Scholar
  15. 15.
    Hossain M (1970) Vitamin-D intoxication during treatment of hypoparathyroidism. Lancet 1(7657):1149–51CrossRefPubMedGoogle Scholar
  16. 16.
    Rubin MR, Dempster DW, Zhou H, Shane E, Nickolas T, Sliney J Jr et al (2008) Dynamic and structural properties of the skeleton in hypoparathyroidism. J Bone Miner Res 23(12):2018–24CrossRefPubMedCentralPubMedGoogle Scholar
  17. 17.
    Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L (2013) Cardiovascular and renal complications to postsurgical hypoparathyroidism: a Danish nationwide controlled historic follow-up study. J Bone Miner Res 28(11):2277–85CrossRefPubMedGoogle Scholar
  18. 18.
    Lienhardt A, Bai M, Lagarde JP, Rigaud M, Zhang Z, Jiang Y et al (2001) Activating mutations of the calcium-sensing receptor: management of hypocalcemia. J Clin Endocrinol Metab 86(11):5313–23CrossRefPubMedGoogle Scholar
  19. 19.
    Raue F, Pichl J, Dorr HG, Schnabel D, Heidemann P, Hammersen G et al (2011) Activating mutations in the calcium-sensing receptor: genetic and clinical spectrum in 25 patients with autosomal dominant hypocalcaemia – a German survey. Clin Endocrinol (Oxf) 75(6):760–5CrossRefGoogle Scholar
  20. 20.
    Winer KK, Ko CW, Reynolds JC, Dowdy K, Keil M, Peterson D et al (2003) Long-term treatment of hypoparathyroidism: a randomized controlled study comparing parathyroid hormone-(1–34) versus calcitriol and calcium. J Clin Endocrinol Metab 88(9):4214–20CrossRefPubMedGoogle Scholar
  21. 21.
    Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI et al (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150(9):604–12CrossRefPubMedCentralPubMedGoogle Scholar
  22. 22.
    Boyce AM, Shawker TH, Hill SC, Choyke PL, Hill MC, James R et al (2013) Ultrasound is superior to computed tomography for assessment of medullary nephrocalcinosis in hypoparathyroidism. J Clin Endocrinol Metab 98(3):989–94CrossRefPubMedCentralPubMedGoogle Scholar
  23. 23.
    Goswami R, Sharma R, Sreenivas V, Gupta N, Ganapathy A, Das S (2012) Prevalence and progression of basal ganglia calcification and its pathogenic mechanism in patients with idiopathic hypoparathyroidism. Clin Endocrinol (Oxf) 77(2):200–6CrossRefGoogle Scholar
  24. 24.
    Fenelon G, Gray F, Paillard F, Thibierge M, Mahieux F, Guillani A (1993) A prospective study of patients with CT detected pallidal calcifications. J Neurol Neurosurg Psychiatry 56(6):622–5CrossRefPubMedCentralPubMedGoogle Scholar
  25. 25.
    Gomille T, Meyer RA, Falkai P, Gaebel W, Konigshausen T, Christ F (2001) Prevalence and clinical significance of computerized tomography verified idiopathic calcinosis of the basal ganglia. Radiologe 41(2):205–10CrossRefPubMedGoogle Scholar
  26. 26.
    Steinberg H, Waldron BR (1952) Idiopathic hypoparathyroidism; an analysis of fifty-two cases, including the report of a new case. Medicine (Baltimore) 31(2):133–54CrossRefGoogle Scholar
  27. 27.
    Ireland AW, Hornbrook JW, Neale FC, Posen S (1968) The crystalline lens in chronic surgical hypoparathyroidism. Arch Intern Med 122(5):408–11CrossRefPubMedGoogle Scholar
  28. 28.
    Pohjola S (1962) Ocular manifestations of idiopathic hypoparathyroidism. Acta Ophthalmol 40:255–65CrossRefGoogle Scholar
  29. 29.
    Kalb RE, Grossman ME (1986) Ectodermal defects and chronic mucocutaneous candidiasis in idiopathic hypoparathyroidism. J Am Acad Dermatol 15(2 Pt 2):353–6CrossRefPubMedGoogle Scholar
  30. 30.
    Pisanty S, Garfunkel A (1977) Familial hypoparathyroidism with candidiasis and mental retardation. Oral Surg Oral Med Oral Pathol 44(3):374–83CrossRefPubMedGoogle Scholar
  31. 31.
    Jensen SB, Illum F, Dupont E (1981) Nature and frequency of dental changes in idiopathic hypoparathyroidism and pseudohypoparathyroidism. Scand J Dent Res 89(1):26–37PubMedGoogle Scholar
  32. 32.
    Nikiforuk G, Fraser D, Poyton HG, McKendry JB (1981) Calcific bridging of dental pulp caused by iatrogenic hypercalcemia. Report of a case. Oral Surg Oral Med Oral Pathol 51(3):317–9CrossRefPubMedGoogle Scholar
  33. 33.
    Vered I, Vered Z, Perez JE, Jaffe AS, Whyte MP (1989) Normal left ventricular performance documented by Doppler echocardiography in patients with long-standing hypocalcemia. Am J Med 86(4):413–6CrossRefPubMedGoogle Scholar
  34. 34.
    Rubin MR, Dempster DW, Kohler T, Stauber M, Zhou H, Shane E et al (2010) Three dimensional cancellous bone structure in hypoparathyroidism. Bone 46(1):190–5CrossRefPubMedCentralPubMedGoogle Scholar
  35. 35.
    Policepatil SM, Caplan RH, Dolan M (2012) Hypocalcemic myopathy secondary to hypoparathyroidism. WMJ 111(4):173–5PubMedGoogle Scholar
  36. 36.
    Roca B, Minguez C, Saez-Royuela A, Simon E (1995) Dementia, myopathy, and idiopathic hypoparathyroidism. Postgrad Med J 71(841):702CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2015

Authors and Affiliations

  1. 1.Endocrine UnitMassachusetts General Hospital, Harvard Medical SchoolBostonUSA

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