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Rejnmark L, Gosmanova EO, Khan AA, Makita N, Imanishi Y, Takeuchi Y, Sprague S, Shoback DM, Kohlmeier L, Rubin MR, Palermo A, Schwarz P, Gagnon C, Tsourdi E, Zhao C, Makara MA, Ominsky MS, Lai B, Ukena J, Sibley CT, Shu AD. Palopegteriparatide Treatment Improves Renal Function in Adults with Chronic Hypoparathyroidism: 1-Year Results from the Phase 3 PaTHway Trial. Adv Ther 2024; 41:2500-2518. [PMID: 38691316 PMCID: PMC11133178 DOI: 10.1007/s12325-024-02843-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 03/12/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION Individuals with chronic hypoparathyroidism managed with conventional therapy (active vitamin D and calcium) have an increased risk for renal dysfunction versus age- and sex-matched controls. Treatments that replace the physiologic effects of parathyroid hormone (PTH) while reducing the need for conventional therapy may help prevent a decline in renal function in this population. This post hoc analysis examined the impact of palopegteriparatide treatment on renal function in adults with chronic hypoparathyroidism. METHODS PaTHway is a phase 3 trial of palopegteriparatide in adults with chronic hypoparathyroidism that included a randomized, double-blind, placebo-controlled 26-week period followed by an ongoing 156-week open-label extension (OLE) period. Changes in renal function over 52 weeks (26 weeks blinded + 26 weeks OLE) were assessed using estimated glomerular filtration rate (eGFR). A subgroup analysis was performed with participants stratified by baseline eGFR < 60 or ≥ 60 mL/min/1.73 m2. RESULTS At week 52, over 95% (78/82) of participants remained enrolled in the OLE and of those, 86% maintained normocalcemia and 95% achieved independence from conventional therapy (no active vitamin D and ≤ 600 mg/day of calcium), with none requiring active vitamin D. Treatment with palopegteriparatide over 52 weeks resulted in a mean (SD) increase in eGFR of 9.3 (11.7) mL/min/1.73 m2 from baseline (P < 0.0001) and 43% of participants had an increase ≥ 10 mL/min/1.73 m2. In participants with baseline eGFR < 60 mL/min/1.73 m2, 52 weeks of treatment with palopegteriparatide resulted in a mean (SD) increase of 11.5 (11.3) mL/min/1.73 m2 (P < 0.001). One case of nephrolithiasis was reported for a participant in the placebo group during blinded treatment; none were reported through week 52 with palopegteriparatide. CONCLUSION In this post hoc analysis of the PaTHway trial, palopegteriparatide treatment was associated with significantly improved eGFR at week 52 in addition to previously reported maintenance and normalization of serum and urine biochemistries. Further investigation of palopegteriparatide for the preservation of renal function in hypoparathyroidism is warranted. TRIAL REGISTRATION ClinicalTrials.gov NCT04701203.
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Affiliation(s)
| | | | | | - Noriko Makita
- The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Yasuo Imanishi
- Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Yasuhiro Takeuchi
- Toranomon Hospital and Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Stuart Sprague
- NorthShore University Health System-University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Dolores M Shoback
- University of California, San Francisco and VA Medical Center, San Francisco, CA, USA
| | - Lynn Kohlmeier
- Endocrinology and Spokane Osteoporosis, Spokane, WA, USA
| | | | - Andrea Palermo
- Fondazione Policlinico Campus Bio-Medico and Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
| | | | - Claudia Gagnon
- CHU de Québec-Université Laval Research Centre and Department of Medicine, Université Laval, Quebec City, QC, Canada
| | - Elena Tsourdi
- Department of Medicine III and Center for Healthy Aging, Technische Universität Dresden, Dresden, Germany
| | - Carol Zhao
- Ascendis Pharma Inc., 1000 Page Mill Rd., Palo Alto, CA, 94304, USA
| | - Michael A Makara
- Ascendis Pharma Inc., 1000 Page Mill Rd., Palo Alto, CA, 94304, USA
| | | | - Bryant Lai
- Ascendis Pharma Inc., 1000 Page Mill Rd., Palo Alto, CA, 94304, USA
| | - Jenny Ukena
- Ascendis Pharma Inc., 1000 Page Mill Rd., Palo Alto, CA, 94304, USA
| | | | - Aimee D Shu
- Ascendis Pharma Inc., 1000 Page Mill Rd., Palo Alto, CA, 94304, USA.
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di Filippo L, Bilezikian JP, Canalis E, Terenzi U, Giustina A. New insights into the vitamin D/PTH axis in endocrine-driven metabolic bone diseases. Endocrine 2024:10.1007/s12020-024-03784-6. [PMID: 38632163 DOI: 10.1007/s12020-024-03784-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 03/13/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Endocrine regulation of bone metabolisms is the focus of the "Skeletal Endocrinology" series of meetings. AIMS To report on the outcome of the discussion on the role of vitamin D/PTH axis in endocrine osteopathies held during the 10th Skeletal Endocrinology Meeting which took place in Stresa (Italy) in March 2023. OUTCOMES Vitamin D/PTH axis has relevant influence on several outcomes in the general population and in patients affected by endocrinopathies such as hypoparathyroidism and secreting pituitary adenomas. CONCLUSIONS Assessing the status of the vitamin D/PTH axis and using vitamin D and PTH as therapeutic agents is mandatory in several endocrine-related bone metabolic conditions.
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Affiliation(s)
- Luigi di Filippo
- Institute of Endocrine and Metabolic Sciences, San Raffaele Vita Salute University and IRCCS San Raffaele Hospital, Milan, Italy
| | - John P Bilezikian
- Department of Medicine, Endocrinology Division, Vagelos College of Physicians and Surgeons Columbia University, New York, NY, USA
| | - Ernesto Canalis
- Department of Orthopaedic Surgery, UConn Health, Farmington, Connecticut, USA; Department of Medicine, UConn Health, Farmington, Connecticut, USA; UConn Musculoskeletal Institute, UConn Health, Farmington, CT, USA
| | - Umberto Terenzi
- Institute of Endocrine and Metabolic Sciences, San Raffaele Vita Salute University and IRCCS San Raffaele Hospital, Milan, Italy
| | - Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, San Raffaele Vita Salute University and IRCCS San Raffaele Hospital, Milan, Italy.
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Bali I, Al Khalifah R. Recombinant PTH Infusion in a Child With Sanjad-Sakati Syndrome Refractory to Conventional Therapy. JCEM CASE REPORTS 2024; 2:luae059. [PMID: 38655381 PMCID: PMC11035914 DOI: 10.1210/jcemcr/luae059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Indexed: 04/26/2024]
Abstract
Hypoparathyroidism is the most common endocrinological feature in children with Sanjad-Sakati syndrome. Treatment includes active vitamin D and calcium supplementation. Here, we report a case of a newborn with Sanjad-Sakati syndrome who had severe hypocalcemia since birth who responded to PTH subcutaneous pump infusion. The child was born at 35 weeks with hypocalcemia since the first day of life. The standard medical treatment proved ineffective for the newborn, necessitating the administration of unusually high doses of oral and IV calcium and vitamin D analogue for a 2 months. As a result, intermittent subcutaneous injections of PTH were commenced, resulting in an initial improvement in calcium levels, although this proved to be short-lived. Subsequently, a switch to continuous infusion via a Medtronic Vio pump was made, which unfortunately resulted in iatrogenic hypercalcemia, requiring management of hypercalcemia. Later, calcium carbonate and alfacalcidol were resumed at a lower dosage and continued to have average requirements for patients with hypoparathyroidism. PTH subcutaneous infusion can be highly effective in refractory hypocalcemia cases and can significantly impact the treatment course and facilitate hospital discharge as seen in our case. Careful dosage and monitoring are required to avoid iatrogenic hypercalcemia.
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Affiliation(s)
- Ibrahim Bali
- Division of Pediatric Endocrinology, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia, 11421- P. O. Box 800
- Pediatric Endocrinology Unit, Department of Pediatrics, King Salman Bin Abdulaziz Medical City, Madina 42319, Saudi Arabia
| | - Reem Al Khalifah
- Division of Pediatric Endocrinology, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia, 11421- P. O. Box 800
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Fujii QS, Shen JJ, Loomba LA. Short Stature and Brachydactyly in an 8-year-old Girl with Congenital Hypothyroidism. Pediatr Rev 2024; 45:234-238. [PMID: 38556508 DOI: 10.1542/pir.2022-005722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Affiliation(s)
- Quinn S Fujii
- University of California Davis School of Medicine, Sacramento, CA
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Khan AA, Abbott LG, Ahmed I, Ayodele O, Gagnon C, Finkelman RD, Mezosi E, Rejnmark L, Takacs I, Yin S, Ing SW. Open-label extension of a randomized trial investigating safety and efficacy of rhPTH(1-84) in hypoparathyroidism. JBMR Plus 2024; 8:ziad010. [PMID: 38741607 PMCID: PMC11090130 DOI: 10.1093/jbmrpl/ziad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/28/2023] [Accepted: 10/31/2023] [Indexed: 05/16/2024] Open
Abstract
Hypoparathyroidism (HypoPT) is a rare disease, often inadequately controlled by conventional treatment. PARALLAX was a mandatory post-marketing trial assessing pharmacokinetics and pharmacodynamics of different dosing regimens of recombinant human parathyroid hormone 1-84 (rhPTH[1-84]) for treating HypoPT. The present study (NCT03364738) was a phase 4, 1-yr open-label extension of PARALLAX. Patients received only 2 doses of rhPTH(1-84) in PARALLAX and were considered treatment-naive at the start of the current study. rhPTH(1-84) was initiated at 50 μg once daily, with doses adjusted based on albumin-corrected serum calcium levels. Albumin-corrected serum calcium (primary outcome measure), health-related quality of life (HRQoL), adverse events, and healthcare resource utilization (HCRU) were assessed. The mean age of the 22 patients included was 50.0 yr; 81.8% were women, and 90.9% were White. By the end of treatment (EOT), 95.5% of patients had albumin-corrected serum calcium values in the protocol-defined range of 1.88 mmol/L to the upper limit of normal. Serum phosphorus was within the healthy range, and albumin-corrected serum calcium-phosphorus product was below the upper healthy limit throughout, while mean 24-h urine calcium excretion decreased from baseline to EOT. Mean supplemental doses of calcium and active vitamin D were reduced from baseline to EOT (2402-855 mg/d and 0.8-0.2 μg/d, respectively). Mean serum bone turnover markers, bone-specific alkaline phosphatase, osteocalcin, procollagen type I N-terminal propeptide, and type I collagen C-telopeptide increased 2-5 fold from baseline to EOT. The HCRU, disease-related symptoms and impact on HRQoL improved numerically between baseline and EOT. Nine patients (40.9%) experienced treatment-related adverse events; no deaths were reported. Treatment with rhPTH(1-84) once daily for 1 yr improved HRQoL, maintained eucalcemia in 95% of patients, normalized serum phosphorus, and decreased urine calcium excretion. The effects observed on urine calcium and the safety profile are consistent with previous findings. Clinical trial identifier NCT03364738.
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Affiliation(s)
- Aliya A Khan
- Divisions of Endocrinology and Metabolism and Geriatric Medicine, McMaster University, Hamilton, Ontario L8S 4L8, Canada
| | - Lisa G Abbott
- Northern Nevada Endocrinology, Reno, NV 89511, United States
- University of Nevada, Reno, NV 89557, United States
| | - Intekhab Ahmed
- Department of Endocrinology and Metabolism, Thomas Jefferson University Hospital, Philadelphia, PA 19107, United States
| | - Olulade Ayodele
- Takeda Development Center Americas Inc., Lexington, MA, 02421, United States
| | - Claudia Gagnon
- Department of Medicine, CHU de Québec-Université Laval Research Centre, Quebec G1V 4G2, Canada
- Department of Medicine, Université Laval, Quebec G1V 0A6, Canada
| | | | - Emese Mezosi
- Department of Internal Medicine, University of Pécs, 7624 Pécs, Hungary
| | - Lars Rejnmark
- Department of Clinical Medicine – Department of Endocrinology and Internal Medicine, Aarhus University, 8200, Aarhus, Denmark
| | - Istvan Takacs
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary
| | - Shaoming Yin
- Takeda Development Center Americas Inc., Lexington, MA, 02421, United States
| | - Steven W Ing
- Division of Endocrinology, Diabetes, and Metabolism, Ohio State University, Columbus, OH 43210, United States
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Soares CSP, Koga KH, Moriguchi SM, Terra SA, Tagliarini JV, de Vasconcelos Affonso PHD, da Silva Pechutti M, da Silva Mazeto GMF. Development of a tool to calculate the probability of hypocalcemia after total thyroidectomy: a prospective study. Langenbecks Arch Surg 2024; 409:33. [PMID: 38195723 DOI: 10.1007/s00423-024-03229-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/03/2024] [Indexed: 01/11/2024]
Abstract
PURPOSE This study aimed to evaluate the ability of the percentage of decrease in serum PTH level in the first 8 h after total thyroidectomy (TT) to predict hypocalcemia requiring Ca supplementation and develop a tool to predict it. METHODS 97 patients who underwent TT with measurement of preoperative parathyroid hormone (PTH) levels were prospectively evaluated 1 and 8 h after TT; postoperative magnesium (Mg2PO) and phosphorus levels were evaluated on the 2nd day after surgery. The percentage of decrease in PTH level 1 h (%dPTH1h) and 8 h (%dPTH8h) postoperatively and predictors of hypocalcemia requiring Ca supplementation were evaluated and an equation was developed to predict this outcome. RESULTS %dPTH1h (p = 0.002), %dPTH8h (p = 0.001) and (Mg2PO) (p < 0.01) were isolated predictors of postoperative hypocalcemia requiring Ca supplementation. The data obtained led to the development of two tools to predict this complication. CONCLUSIONS The percentage of decrease in PTH level 1 h and 8 h postoperatively and the magnesium level on the 2nd day after surgery were predictors of more severe hypocalcemia, and an auxiliary tool for predicting this complication was developed.
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Affiliation(s)
- Carlos Segundo Paiva Soares
- Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - Unesp, Botucatu, SP, 18618970, Brazil.
- Department of Surgical Specialties and Anesthesiology, Av. Professor Mário Rubens Guimarães Montenegro, s/n, UNESP Campus de Botucatu, Botucatu, SP, CEP 18618-687, Brazil.
| | - Katia Hiromoto Koga
- Nuclear Medicine Department, Botucatu Medical School, Sao Paulo State University - Unesp, Botucatu, SP, 18618970, Brazil
| | - Sonia Marta Moriguchi
- Nuclear Medicine Department, Botucatu Medical School, Sao Paulo State University - Unesp, Botucatu, SP, 18618970, Brazil
| | - Simone Antunes Terra
- Pathology Department, Botucatu Medical School, Sao Paulo State University - Unesp, Botucatu, SP, 18618970, Brazil
| | - José Vicente Tagliarini
- Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - Unesp, Botucatu, SP, 18618970, Brazil
| | | | - Monise da Silva Pechutti
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University - Unesp, Botucatu, SP, 18618970, Brazil
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Abdolmaleki M, Ohadi L, Maleki S. Dilated cardiomyopathy in patients with hypoparathyroidism: A narrative review. Health Sci Rep 2024; 7:e1796. [PMID: 38186939 PMCID: PMC10766877 DOI: 10.1002/hsr2.1796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/23/2023] [Accepted: 12/17/2023] [Indexed: 01/09/2024] Open
Abstract
Background Hypoparathyroidism is a rare endocrine disorder characterized by low blood calcium levels, elevated phosphorus levels, and insufficient parathyroid hormone production. It can lead to dilated cardiomyopathy (DCM), a cardiac condition characterized by enlarged ventricles and reduced heart function. This review aims to explore the relationship between hypoparathyroidism and DCM, the impact of calcium on cardiac function, and the potential for DCM reversal with calcium supplementation. Methods A comprehensive literature search was conducted using PubMed, Google Scholar, and relevant keywords and Mesh terms. Case reports evaluating dilated cardiomyopathy in patients with Hypoparathyroidism were included in the study. Additionally, references cited in each study were carefully examined to identify relevant reports. The cases included in the review were analyzed, and common cardiac manifestations, diagnostic approaches, and management were identified. Results DCM in hypoparathyroidism presents with symptoms of heart failure, reduced ejection fraction, and impaired left ventricular function. Laboratory tests show low serum calcium levels and elevated phosphate levels. Prompt diagnosis and treatment with calcium and vitamin D supplementation can lead to improvements in cardiac function. Conclusion Hypoparathyroidism-induced DCM is reversible with timely calcium and vitamin D supplementation. Patient compliance with prescribed medications and supplements is crucial to prevent and manage cardiac complications. Regular follow-up check-ups and monitoring of calcium levels can aid in early detection and improve patient outcomes. Educating patients about the importance of treatment adherence can significantly reduce the risk of developing DCM and other cardiac symptoms associated with hypoparathyroidism. Routine follow-up of DCM among patients with endocrine disorders is recommended.
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Affiliation(s)
| | - Laya Ohadi
- Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Saba Maleki
- School of Medicine Guilan University of Medical Sciences Rasht Iran
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Goncu B, Yucesan E, Salepcioglu Kaya H, Kazancioglu R, Ersoy YE, Akcakaya A. The Challenge of Preoperative Panel Reactive Antibody Positivity in Parathyroid Transplantation. EXP CLIN TRANSPLANT 2024; 22:233-242. [PMID: 38385404 DOI: 10.6002/ect.mesot2023.p59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
OBJECTIVES Identifying suitable recipient criteria and matching recipients with appropriate donors are required to increase survival for parathyroid transplant. This study was undertaken to evaluate transplant survival rates while comparing preoperative panel reactive antibody positivity. MATERIALS AND METHODS The study included 14 hypoparathyroidism patients who presented to our clinic for parathyroid transplant. Preoperative ABO compatibility and negative cross-match tests were prioritized for recipient-donor matching, and panel reactive antibody screening tests were performed. During the 24-month follow-up, we evaluated medication use and serum calcium, phosphorus, and parathormone levels of patients. RESULTS Preoperative panel reactive antibody positivity was assessed in 3 groups. The HLA class I-positive group (mean fluorescence intensity range, 179-1770) showed decreased medication use and stability in serum calcium levels. The HLA class IIpositive (mean fluorescence intensity range, 85-3959) showed decreased medication use by 25% to 50% and returned to their former prescription doses after 12 months. An opposite pattern was observed in 2 patients with panel reactive antibody positivity for both HLA classes (mean fluorescence intensity range, 462-2289), with 1 patient requiring medication for continuing symptoms and the other patient occasionally taking additional magnesium supplementation, despite decreased medication doses after 12 months. Serum calcium levels remained normal, and parathormone and phosphorus levels were elevated. CONCLUSIONS Improving patient symptoms and having no requirement for intravenous calcium replacement are priorities, and monitoring serum levels is the next important step. Varied panel reactive antibody positivities and survival rates indicate a requirement, and each HLA class could require a proper limitation for the mean fluorescence intensity. Preoperative mean fluorescence intensity cut-off value should be <900. Higher mean fluorescence intensity values in panel reactive antibody screenings could increase risk of short-term graft survival after parathyroid transplant. Further studies should include immunological risk assessments by individualizing the outcome with donor-specific antibodies.
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Affiliation(s)
- Beyza Goncu
- From the Department of Medical Services and Techniques, Vocational School of Health Services, Bezmialem Vakif University; and the Parathyroid Transplantation Unit, Organ Transplantation Center, Bezmialem Vakif University Hospital, Istanbul, Türkiye
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Hochberg A, Pare A, Badeghiesh AM, Baghlaf HA, Dahan MH. Pregnancy, delivery and neonatal outcomes among women with hypoparathyroidism-A population-based study. Clin Endocrinol (Oxf) 2023; 99:525-532. [PMID: 37694589 DOI: 10.1111/cen.14969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/24/2023] [Accepted: 08/27/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE Data are inconclusive regarding pregnancy complications associated with maternal chronic hypoparathyroidism. Therefore, we aimed to compare pregnancy, delivery and neonatal outcomes in patients affected by chronic hypoparathyroidism to those without chronic hypoparathyroidism. DESIGN A retrospective population-based study utilising data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) database over 11 years from 2004 to 2014 inclusively. Multivariate logistic regression was used to control for confounders. PATIENTS Patients with chronic hypoparathyroidism compared with those without. MEASUREMENTS Obstetric and neonatal outcomes. RESULTS We identified 204 pregnancies in mothers with chronic hypoparathyroidism and 9,096,584 pregnancies without chronic hypoparathyroidism. After adjusting for age, insurance plan type, obesity, chronic hypertension, thyroid disease, pregestational diabetes mellitus, and previous caesarean section, patients in the hypoparathyroidism group, compared with those without hypoparathyroidism, were found to have an increased rate of preterm birth (<37 weeks) (19.1% vs. 7.2%, aOR: 2.49, 95% confidence interval [CI]: 1.74-3.54, p < 0.0001, respectively); and blood transfusions (4.9% vs. 1.0%, aOR: 4.07, 95% CI: 2.15-7.73, p < -0.0001). Neonates to mothers with chronic hypoparathyroidism had a higher rate of congenital anomalies (4.4% vs. 0.4%, aOR: 6.50, 95% CI: 3.31-12.75, p < 0.0001), with comparable rates of small-for-gestational-age neonates and intrauterine foetal death. CONCLUSION This is the largest study of chronic hypoparathyroidism in pregnancy to date. We found significant increases in the rates of preterm birth, blood transfusions and congenital anomalies in chronic hypoparathyroidism. Our findings highlight the importance of identifying chronic hypoparathyroidism as a risk factor for pregnancy and neonatal complications, although it remains unknown if maintaining calcium in the target range will mitigate these risks.
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Affiliation(s)
- Alyssa Hochberg
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aurelie Pare
- Division of Endocrinology and Metabolism, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Ahmad M Badeghiesh
- Department of Obstetrics and Gynecology, Western University, London, Ontario, Canada
| | - Haitham A Baghlaf
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
| | - Michael H Dahan
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
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Canat MM, Batman A, Dönmez Ç, Köstek H, Köstek M, Kara ZMY, Öztürk FY, Altuntaş Y. The effects of adequate dietary calcium intake in patients with hypoparathyroidism non-adherent to treatment: a prospective randomized controlled trial. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230406. [PMID: 37909613 PMCID: PMC10610765 DOI: 10.1590/1806-9282.20230406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/03/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE A significant problem that compels clinicians in the conventional treatment of hypoparathyroidism is patients' non-adherence to treatment. This study aimed to evaluate the effects of adequate Ca intake with dietary recommendations among hypoparathyroidism patients who persistently use Ca supplementation irregularly on plasma Ca and phosphate levels. METHODS This prospective, randomized, controlled study was conducted on patients diagnosed with chronic hypoparathyroidism who persistently interrupt Ca supplementation therapy and therefore have a hypocalcemic course. Patients with a total daily Ca intake below 800 mg were randomized. All patients were advised to keep the doses of active vitamin D and Ca supplements they were currently using. The patients in the study group (n=32) were advised to consume 1,000-1,200 mg of Ca daily, and the patients in the control group (n=35) were advised to continue their diet according to their daily habits. After 12 weeks of follow-up, the patients' laboratory values were compared between groups to assess treatment goals. RESULTS The mean of the total Ca level was 8.56±0.36 mg/dL in the study group and was found to be significantly higher than that in the control group, which was 7.67±0.48 mg/dL (p<0.001). The mean serum phosphate and serum Ca-P product levels were significantly higher in the study group (p<0.001) but did not exceed the safe upper limits in any patient. CONCLUSION A suitable increase in dietary Ca intake could effectively control hypocalcemia in patients with hypoparathyroidism who persistently interrupt the recommended calcium supplementation.
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Affiliation(s)
- Muhammed Masum Canat
- University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Department of Endocrinology and Metabolism – Istanbul, Turkey
| | - Adnan Batman
- Koc University, School of Medicine, Department of Endocrinology and Metabolism – Istanbul, Turkey
| | - Çiğdem Dönmez
- University of Health Sciences, Şişli Hamidiye Etfal Training And Research Hospital, Department of Nutrition – Istanbul, Turkey
| | - Hatice Köstek
- University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Department of Endocrinology and Metabolism – Istanbul, Turkey
| | - Mehmet Köstek
- University of Health Sciences, Şişli Hamidiye Etfal Training And Research Hospital, Department of General Surgery – Istanbul, Turkey
| | - Zeynep Mine Yalçınkaya Kara
- University of Health Sciences, Şişli Hamidiye Etfal Training And Research Hospital, Department of Biochemistry – Istanbul, Turkey
| | - Feyza Yener Öztürk
- University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Department of Endocrinology and Metabolism – Istanbul, Turkey
| | - Yüksel Altuntaş
- University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Department of Endocrinology and Metabolism – Istanbul, Turkey
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Büttner M, Krogh D, Führer D, Fuß CT, Willenberg HS, Luster M, Singer S, Siggelkow H. Hypoparathyroidism - management, information needs, and impact on daily living from the patients' perspective: results from a population-based survey. Hormones (Athens) 2023; 22:467-476. [PMID: 37380916 PMCID: PMC10449945 DOI: 10.1007/s42000-023-00459-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 06/09/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE Hypoparathyriodism (hypoPT) is a rare endocrine disorder. It is not known how hypoPT is managed in Germany or whether patients have unmet information needs or impairments in their daily living. METHODS HypoPT patients at a minimum of 6 months' post-diagnosis were invited to participate in an online survey through their treating physician or through patient organizations. An extensive questionnaire, which was developed and pilot-tested with hypoPT patients, was administered. RESULTS A total of 264 patients with a mean age of 54.5 years (SD: 13.3), 85.2% female and 92% with postsurgical hypoPT, participated in the study. In total, 74% of the patients reported regular monitoring of serum calcium at least every 6 months, with lower control frequencies for phosphate (47%), magnesium (36%), creatinine (54%), and parathyroid hormone (50%), and 24-h urine calcium excretion (36%) on a yearly basis. Information on symptoms of hypo- and hypercalcemia was available in 72 and 45% of the patients. Information needs were related to the disease and its treatment as well as to nutrition, physical activities/sports, and support opportunities. Statistically significant differences for all information needs in association with symptom burden were observed. Hospitalization for hypocalcemia was reported by 32%, nutritional impairments (38%) or impact on work ability (52%) was available among patients with hypoPT. CONCLUSION HypoPT patients experience impairments in daily living and report unmet information needs. Patient and physician education regarding hypoPT is one of the key concepts for improving the management of patients with hypoPT.
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Affiliation(s)
- Matthias Büttner
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Obere Zahlbacher Straße 69, 55131, Mainz, Germany.
- University Cancer Centre, Mainz, Germany.
| | - Dieter Krogh
- Netzwerk Hypopara im Bundesverband Schilddrüsenkrebs - Ohne Schilddrüse leben e.V., Berlin, Germany
| | - Dagmar Führer
- Department of Endocrinology, Diabetes and Metabolism and Division of Laboratory Research, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Carmina Teresa Fuß
- Division of Endocrinology and Diabetes, Department of Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
| | - Holger Sven Willenberg
- Division of Endocrinology and Metabolism, Rostock University Medical Center, Rostock, Germany
| | - Markus Luster
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Obere Zahlbacher Straße 69, 55131, Mainz, Germany
- University Cancer Centre, Mainz, Germany
| | - Heide Siggelkow
- Clinic of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University of Göttingen, Göttingen, Germany
- MVZ Endokrinologikum Göttingen, Göttingen, Germany
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12
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Ali DS, Marini F, Alsarraf F, Alalwani H, Alamri A, Khan AA, Brandi ML. Case Report: Calcium sensing receptor gene gain of function mutations: a case series and report of 2 novel mutations. Front Endocrinol (Lausanne) 2023; 14:1215036. [PMID: 37654565 PMCID: PMC10466028 DOI: 10.3389/fendo.2023.1215036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/20/2023] [Indexed: 09/02/2023] Open
Abstract
Autosomal dominant hypocalcemia (ADH1) is a genetic disorder characterized by low serum calcium and low or inappropriately normal levels of parathyroid hormone. The disease is caused by a heterozygous activating mutation of the calcium-sensing receptor (CaSR) gene, encoding a G-Protein-coupled cell membrane sensor of extracellular calcium concentration mainly expressed by parathyroid glands, renal tubules, and the brain. ADH1 has been linked to 113 unique germline mutations, of which nearly 96% are missense mutations. There is often a lack of a clear genotype/phenotype correlation in the reported literature. Here, we described a case series of 6 unrelated ADH1 probands, each one bearing a gain-of-function CaSR mutation, and two children of one of these cases, matching our identified mutations to the same ones previously reported in the literature, and comparing the clinical and biochemical characteristics, as well as the complication profile. As a result of these genetic and clinical comparisons, we propose that a genotype/phenotype correlation may exist because our cases showed similar presentation, characteristics, and severity, with respect to published cases with the same or similar mutations. We also contend that the severity of the presentation is highly influenced by the specific CaSR variant. These findings, however, require further evaluation and assessment with a systematic review.
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Affiliation(s)
- Dalal S. Ali
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, ON, Canada
| | - Francesca Marini
- Fondazione Italiana Ricerca sulle Malattie dell'Osso (FIRMO) Onlus, Italian Foundation for the Research on Bone Diseases, Florence, Italy
| | - Farah Alsarraf
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, ON, Canada
| | - Hatim Alalwani
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, ON, Canada
| | - Abdulrahman Alamri
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, ON, Canada
| | - Aliya A. Khan
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, ON, Canada
| | - Maria Luisa Brandi
- Fondazione Italiana Ricerca sulle Malattie dell'Osso (FIRMO) Onlus, Italian Foundation for the Research on Bone Diseases, Florence, Italy
- Donatello Bone Clinic, Villa Donatello Hospital, Sesto Fiorentino, Italy
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13
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Ing SW, Finkelman RD, He P, Khan AA, Mannstadt M, Rejnmark L, Song I, Takács I, Wu Y. A Phase I Randomized Trial of Once-Daily Versus Twice-Daily Recombinant Human Parathyroid Hormone (1-84) for Hypoparathyroidism. JBMR Plus 2023; 7:e10758. [PMID: 37457880 PMCID: PMC10339078 DOI: 10.1002/jbm4.10758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/05/2023] [Accepted: 04/26/2023] [Indexed: 07/18/2023] Open
Abstract
Recombinant human parathyroid hormone (1-84), rhPTH(1-84), is an approved adjunctive treatment to oral calcium and active vitamin D for adult patients with hypoparathyroidism; however, there is limited information on the effect of twice daily (BID) dosing of rhPTH(1-84). This was a phase I, open-label, randomized, crossover, multicenter study conducted in adult patients with chronic hypoparathyroidism. The primary objective was to assess the pharmacokinetic profile and pharmacodynamic effects of 1 day of treatment with rhPTH(1-84) administered subcutaneously at 25 μg BID, 50 μg BID, and 100 μg once daily (QD) with or without supplemental oral calcium. Safety and tolerability were evaluated as secondary objectives. In total, 33 patients with chronic hypoparathyroidism completed the study. Treatment with rhPTH(1-84), both BID and QD, over the short-term maintained serum calcium, lowered serum phosphorus, decreased urinary calcium excretion, and increased urinary phosphorus excretion. The decrease in urinary calcium excretion was numerically greater for BID than QD. Generally, baseline-adjusted pharmacokinetic parameters including area under the curve and maximum observed concentration increased with increasing rhPTH(1-84) dose, although this effect was not dose proportional. No new safety findings were observed. Our study revealed no differences thought to be clinically meaningful in pharmacokinetic or pharmacodynamic parameters with BID versus QD rhPTH(1-84) dosing. Future long-term studies are warranted to further elucidate the effects of alternative dosing strategies. © 2023 Takeda Development Center Americas, Inc and The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Steven W. Ing
- Division of Endocrinology, Diabetes, and MetabolismOhio State University Wexner Medical CenterColumbusOHUSA
| | | | - Ping He
- Takeda Pharmaceuticals USA, Inc.LexingtonMAUSA
| | - Aliya A. Khan
- Divisions of Endocrinology and Metabolism and GeriatricsMcMaster UniversityOakvilleONCanada
| | - Michael Mannstadt
- Endocrine UnitMassachusetts General Hospital and Harvard Medical SchoolBostonMAUSA
| | - Lars Rejnmark
- Department of Clinical Medicine – Department of Endocrinology and Internal MedicineAarhus University and Aarhus University HospitalAarhusDenmark
| | - Ivy Song
- Takeda Pharmaceuticals USA, Inc.LexingtonMAUSA
| | - István Takács
- Department of Internal Medicine and OncologySemmelweis UniversityBudapestHungary
| | - Yuna Wu
- Takeda Pharmaceuticals USA, Inc.LexingtonMAUSA
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14
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Cardona Z, Sosman JA, Chandra S, Huang W. Endocrine side effects of immune checkpoint inhibitors. Front Endocrinol (Lausanne) 2023; 14:1157805. [PMID: 37251665 PMCID: PMC10210589 DOI: 10.3389/fendo.2023.1157805] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/05/2023] [Indexed: 05/31/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) have increasingly been the mainstay of treatment for numerous malignancies. However, due to their association with autoimmunity, ICIs have resulted in a variety of side effects that involve multiple organs including the endocrine system. In this review article, we describe our current understanding of the autoimmune endocrinopathies as a result of the use of ICIs. We will review the epidemiology, pathophysiology, clinical presentation, diagnosis, and management of the most commonly encountered endocrinopathies, including thyroiditis, hypophysitis, Type 1 diabetes, adrenalitis, and central diabetes insipidus.
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Affiliation(s)
- Zulma Cardona
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jeffrey A. Sosman
- Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sunandana Chandra
- Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Wenyu Huang
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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15
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Agarwal S, McMahon DJ, Chen J, Brossfield A, Fernando J, Bilezikian JP, Cusano NE, Rubin MR. The Clinical and Skeletal Effects of Long-Term Therapy of Hypoparathyroidism With rhPTH(1-84). J Bone Miner Res 2023; 38:480-492. [PMID: 36726204 PMCID: PMC10101915 DOI: 10.1002/jbmr.4780] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 01/16/2023] [Accepted: 01/25/2023] [Indexed: 02/03/2023]
Abstract
Hypoparathyroidism (HypoPT) is a disorder characterized by hypocalcemia, low or absent parathyroid hormone (PTH) levels, reduced bone remodeling, and high areal bone mineral density (aBMD). PTH is a therapeutic option, yet data on the prolonged clinical and skeletal effects of PTH treatment are limited. We tracked annual daily doses of calcium and active vitamin D supplements, calciotropic biochemistries, estimated glomerular filtration rate (eGFR), and aBMD measurements in 27 HypoPT patients (16 postsurgical, 11 nonsurgical) who were treated with recombinant human PTH(1-84) [rhPTH(1-84)] for at least 8 (n = 27) and up to 12 (n = 14) years. We also performed high-resolution-peripheral quantitative computed tomography (HRpQCT) imaging and report results at baseline, 5, 8, and 12 years of rhPTH(1-84) treatment. With prolonged use of rhPTH, reductions in the need for supplemental calcium and active vitamin D were maintained. The eGFR did not decline. Serum calcium was maintained within the lower limit of the normal range. aBMD by dual-energy X-ray absorptiometry (DXA) showed an increase at the lumbar spine and a decrease at the distal 1/3 radius. By HRpQCT, cortical volumetric BMD (vBMD) at the tibia decreased at year 5: -20.0% ± 1.5%. The magnitude of this reduction was mitigated in year 8: -8.5% ± 1.6% and in year 12: -10.3% ± 2.2% but all were significantly below the mean baseline value (p < 0.001). A similar pattern of decline was observed at the radius. Cortical porosity progressively increased at the tibia in year 5: 17.4% ± 10% (p < 0.05), year 8: 55.2% ± 11% (p < 0.001), and year 12: 83.5% ± 14% (p < 0.001). A similar pattern of increase was observed at the radius. Failure load, which was higher than normal at baseline, decreased but remained above normal at year 12. This is the longest experience, to date, with PTH therapy in HypoPT. These results demonstrate sustained biochemical stability but overall decreases in bone mass. © 2023 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Sanchita Agarwal
- Metabolic Bone Disease Unit, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY
| | - Donald J. McMahon
- Metabolic Bone Disease Unit, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY
| | - Juliet Chen
- Sophie Davis Program for Biomedical Education, CUNY School of Medicine, New York, NY
| | - Aiden Brossfield
- Metabolic Bone Disease Unit, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY
| | - Jason Fernando
- Metabolic Bone Disease Unit, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY
| | - John P. Bilezikian
- Metabolic Bone Disease Unit, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY
| | | | - Mishaela R. Rubin
- Metabolic Bone Disease Unit, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY
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16
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Kaul S, Ayodele O, Chen K, Cook EE, Swallow E, Rejnmark L, Gosmanova EO. Association of Serum Calcium and Phosphate With Incident Cardiovascular Disease in Patients With Hypoparathyroidism. Am J Cardiol 2023; 194:60-70. [PMID: 36989548 DOI: 10.1016/j.amjcard.2023.01.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/11/2023] [Accepted: 01/14/2023] [Indexed: 03/31/2023]
Abstract
The pathophysiological basis for the increased incidence of cardiovascular disease in patients with chronic hypoparathyroidism is poorly understood. To evaluate associations between levels of albumin-corrected serum calcium, serum phosphate, and calcium-phosphate product with the odds of developing cardiovascular events in patients with chronic hypoparathyroidism with ≥1 calcitriol prescription, we conducted a retrospective nested case-control study of patients who developed a cardiovascular event and matched controls without an event. The primary outcome was the instance of cardiovascular events. An electronic medical record database was used to identify 528 patients for the albumin-corrected serum calcium analysis and 200 patients for the serum phosphate and calcium-phosphate product analyses. Patients with ≥67% of albumin-corrected serum calcium measurements outside the study-defined 2.00 to 2.25 mmol/L (8.0 to 9.0 mg/100 ml) range had 1.9-fold higher odds of a cardiovascular event (adjusted odds ratio, 95% confidence interval 1.89, 1.10 to 3.25) compared with patients with <33% of calcium measurements outside the range. Likewise, patients with any serum phosphate measurements above 0.81 to 1.45 mmol/L (2.5 to 4.5 mg/100 ml) had 3.3-fold higher odds (3.26; 1.24 to 8.58), and those with any calcium-phosphate product measurements above 4.40 mmol2/L2 (55 mg2/dL2) had 4.8-fold higher odds of a cardiovascular event (95% confidence interval 1.36 to 16.81) compared with patients with no measurements above these ranges. In adult patients with chronic hypoparathyroidism, a cardiovascular event was more likely in those with a higher proportion of albumin-corrected serum calcium measurements outside 2.00 to 2.25 mmol/L (8.0 to 9.0 mg/100 ml) or any serum phosphate and any calcium-phosphate product measurements above the normal population range.
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Affiliation(s)
- Sanjiv Kaul
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon.
| | - Olulade Ayodele
- Takeda Pharmaceuticals United States, Inc., Lexington, Massachusetts
| | - Kristina Chen
- Takeda Pharmaceuticals United States, Inc., Lexington, Massachusetts
| | | | | | - Lars Rejnmark
- Department of Clinical Medicine - Department of Endocrinology and Diabetes, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
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17
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Watts NB, Bilezikian JP, Bone HG, Clarke BL, Denham D, Levine MA, Mannstadt M, Peacock M, Rothman JG, Vokes TJ, Warren ML, Yin S, Sherry N, Shoback DM. Long-Term Safety and Efficacy of Recombinant Human Parathyroid Hormone (1-84) in Adults With Chronic Hypoparathyroidism. J Endocr Soc 2023; 7:bvad043. [PMID: 37091306 PMCID: PMC10119703 DOI: 10.1210/jendso/bvad043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Indexed: 04/07/2023] Open
Abstract
Context Chronic hypoparathyroidism is conventionally treated with oral calcium and active vitamin D to reach and maintain targeted serum calcium and phosphorus levels, but some patients remain inadequately controlled. Objective To assess long-term safety and efficacy of recombinant human parathyroid hormone (1-84) (rhPTH(1-84)) treatment. Methods This was an open-label extension study at 12 US centers. Adults (n = 49) with chronic hypoparathyroidism were included. The intervention was rhPTH(1-84) for 6 years. The main outcome measures were safety, biochemical measures, oral supplement doses, bone indices. Results Thirty-eight patients (77.6%) completed the study. Throughout 72 months, mean albumin-adjusted serum calcium was within 2.00 to 2.25 mmol/L (8.0-9.0 mg/dL). At baseline, 65% of patients with measurements (n = 24/37) were hypercalciuric; of these, 54% (n = 13/24) were normocalciuric at month 72. Mean serum phosphorus declined from 1.6 ± 0.19 mmol/L at baseline (n = 49) to 1.3 ± 0.20 mmol/L at month 72 (n = 36). Mean estimated glomerular filtration rate was stable. rhPTH(1-84)-related adverse events were reported in 51.0% of patients (n = 25/49); all but 1 event were mild/moderate in severity. Mean oral calcium supplementation reduced by 45% ± 113.6% and calcitriol by 74% ± 39.3%. Bone turnover markers declined by month 32 to a plateau above pretreatment values; only aminoterminal propeptide of type 1 collagen remained outside the reference range. Mean bone mineral density z score fell at one-third radius and was stable at other sites. Conclusion 6 years of rhPTH(1-84) treatment was associated with sustained improvements in biochemical parameters, a reduction in the percentage of patients with hypercalciuria, stable renal function, and decreased supplement requirements. rhPTH(1-84) was well tolerated; no new safety signals were identified.
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Affiliation(s)
- Nelson B Watts
- Osteoporosis and Bone Health Services, Mercy Health, Cincinnati, OH 45236, USA
| | - John P Bilezikian
- Division of Endocrinology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Henry G Bone
- Michigan Bone and Mineral Clinic, PC, Detroit, MI 48236, USA
| | - Bart L Clarke
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN 55905, USA
| | - Douglas Denham
- Clinical Trials of Texas, Inc., San Antonio, TX 78229, USA
| | - Michael A Levine
- Division of Endocrinology and Diabetes and Center for Bone Health, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Michael Mannstadt
- Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Munro Peacock
- Department of Medicine, Division of Endocrinology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | | | - Tamara J Vokes
- Section of Endocrinology, University of Chicago Medicine, Chicago, IL 60637, USA
| | - Mark L Warren
- Endocrinology and Metabolism, Physicians East, PA, Greenville, NC 27834, USA
| | - Shaoming Yin
- Takeda Pharmaceuticals USA, Inc., Lexington, MA 02421, USA
| | - Nicole Sherry
- Takeda Pharmaceuticals USA, Inc., Lexington, MA 02421, USA
| | - Dolores M Shoback
- Endocrine Research Unit, San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA
- Department of Medicine, University of California, San Francisco, CA 94143, USA
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18
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Onder CE, Kuskonmaz SM, Koc G, Firat SN, Omma T, Culha C. Evaluation of management of patients with postoperative permanent hypoparathyroidism. How close are we to the targets? Minerva Endocrinol (Torino) 2023; 48:12-18. [PMID: 33269571 DOI: 10.23736/s2724-6507.20.03291-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Postoperative hypoparathyroidism (PO-HypoPT) is a complication usually seen after thyroid surgery. PO-HypoPT, which lasts longer than 6 months is defined permanently. The aim of this study was to evaluate how close permanent PO-HypoPT patients can approach target values. METHODS One hundred seven patients who were followed-up with permanent diagnosis of PO-HypoPT between 2016-2020 were included in the study. The study protocol includes serum albumin corrected total calcium (Alb-sCa), phosphate (P), Ca-P product, and 24 h urine calcium measurements. Laboratory measurements of the patients include the values recorded in 4-year visits and in the last visit. In addition, radiological reports of renal/abdominal ultrasound and cranial tomography examinations performed in our hospital for any reason during this period were also reviewed. RESULTS When looking at the total measurements in the 4-year period, the Alb-sCa level was below the target in most of the measurements (68.1%). P level was higher than normal in 296 (46.2%) measurements. Twenty-four h urine ca excretion was measured 185 times in total visits, and 81 (43.7%) of these measurements showed hypercalciuric values. The patient's latest visit measurements were evaluated on 4 targets (Alb-sCa, P, Ca-P product and 24 h urine Ca excretion). The number of patients meeting all four targets was only 21 (19.6%). Six (7.5%) patients had kidney stones or nephrocalcinosis. Three (0.09%) patients with imaging had calcification in the basal ganglia. CONCLUSIONS Our study shows that the management of the patients with PO-HypoPT is suboptimal with active vitamin D and cholecalciferol treatment.
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Affiliation(s)
- Cagatay E Onder
- Department of Endocrinology and Metabolism, Ankara Training and Research Hospital, Ankara, Türkiye -
| | - Serife M Kuskonmaz
- Department of Endocrinology and Metabolism, Ankara Training and Research Hospital, Ankara, Türkiye
| | - Gonul Koc
- Department of Endocrinology and Metabolism, Ankara Training and Research Hospital, Ankara, Türkiye
| | - Sevde N Firat
- Department of Endocrinology and Metabolism, Ankara Training and Research Hospital, Ankara, Türkiye
| | - Tulay Omma
- Department of Endocrinology and Metabolism, Ankara Training and Research Hospital, Ankara, Türkiye
| | - Cavit Culha
- Department of Endocrinology and Metabolism, Ankara Training and Research Hospital, Ankara, Türkiye
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19
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Díaz-Brochero C, Diaz-Tribaldos DC, Arteaga-Díaz JM, González-Villa AM, Peralta Franco JJ. Seudohipoparatiroidismo: enfermedad huérfana en endocrinología. Reporte de un caso. CASE REPORTS 2023. [DOI: 10.15446/cr.v8n2.93719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Resumen
Introducción. El seudohipoparatiroidismo (SPT) es un trastorno genético poco frecuente que se caracteriza por la resistencia a la hormona paratiroidea (PTH). En Colombia existen pocos reportes sobre esta enfermedad, por lo que la publicación del presente caso contribuye a aumentar el interés en su búsqueda en el ámbito clínico.
Presentación del caso. Hombre de 18 años con antecedente de hipotiroidismo (diagnosticado a los 4 meses de nacido), retraso del crecimiento, desarrollo puberal tardío, obesidad, braquidactilia, fracturas patológicas, osteocondroma femoral, insomnio, parestesias y estreñimiento crónico, quien asistió al servicio de endocrinología de un hospital de tercer nivel de Bogotá (Colombia) remitido luego de haber estado hospitalizado por un episodio convulsivo. En dicha hospitalización los laboratorios evidenciaron hipocalcemia, hiperfosfatemia y 25-OH vitamina D en rango de insuficiencia con niveles elevados de PTH, y los estudios imagenológicos demostraron osificaciones heterotópicas y calcificaciones de ganglios basales del cerebro. Al paciente se le realizó un estudio genético que confirmó el diagnóstico de SPT1A, por lo que se le inició manejo con suplencia de calcio, colecalciferol y quelantes de fósforo, con lo cual evolucionó satisfactoriamente. Tanto el paciente como sus familiares de primer grado recibieron asesoramiento y valoración interdisciplinaria.
Conclusiones. El SPT1A es un trastorno genético complejo poco conocido pero de alta importancia clínica dentro de los diagnósticos diferenciales de hipocalcemia que debe considerarse ya que sin el diagnóstico y tratamiento oportunos, los pacientes pueden presentar consecuencias metabólicas graves y potencialmente fatales.
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20
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Khan AA, Guyatt G, Ali DS, Bilezikian JP, Collins MT, Dandurand K, Mannstadt M, Murphy D, M'Hiri I, Rubin MR, Sanders R, Shrayyef M, Siggelkow H, Tabacco G, Tay YKD, Van Uum S, Vokes T, Winer KK, Yao L, Rejnmark L. Management of Hypoparathyroidism. J Bone Miner Res 2022; 37:2663-2677. [PMID: 36161671 DOI: 10.1002/jbmr.4716] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 12/24/2022]
Abstract
Hypoparathyroidism (HypoPT) is a rare disorder characterized by hypocalcemia in the presence of a low or inappropriately normal parathyroid hormone level. HypoPT is most commonly seen after neck surgery, which accounts for approximately 75% of cases, whereas approximately 25% have HypoPT due to nonsurgical causes. In both groups of patients, conventional therapy includes calcium and active vitamin D analogue therapy aiming to maintain serum calcium concentration in the low normal or just below the normal reference range and normalize serum phosphorus, magnesium concentrations, and urine calcium levels. The limitations of conventional therapy include wide fluctuations in serum calcium, high pill burden, poor quality of life, and renal complications. Parathyroid hormone (PTH) replacement therapy may improve the biochemical profile in those in whom conventional therapy proves unsatisfactory. Based on a systematic review and meta-analysis of the literature, the panel made a graded recommendation suggesting conventional therapy as first line therapy rather than administration of PTH (weak recommendation, low quality evidence). When conventional therapy is deemed unsatisfactory, the panel considers use of PTH. Because pregnancy and lactation are associated with changes in calcium homeostasis, close monitoring is required during these periods with appropriate adjustment of calcium and active vitamin D analogue therapy to ensure that serum calcium remains in the mid to low normal reference range in order to avoid maternal and fetal complications. Emerging therapies include molecules with prolonged PTH action as well as different mechanisms of action that may significantly enhance drug efficacy and safety. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Aliya A Khan
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Dalal S Ali
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, Canada
| | - John P Bilezikian
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Michael T Collins
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - Karel Dandurand
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, Canada
| | - Michael Mannstadt
- Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Iman M'Hiri
- Bone Research and Education Centre, Oakville, Canada
| | - Mishaela R Rubin
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | | | | | - Heide Siggelkow
- Clinic of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Goettingen, Goettingen, Germany.,MVZ Endokrinologikum Goettingen, Goettingen, Germany
| | - Gaia Tabacco
- Unit of Metabolic Bone and Thyroid Diseases, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.,Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | - Yu-Kwang Donovan Tay
- Department of Medicine, Sengkang General Hospital, Singhealth and Duke-NUS Medical School, Singapore, Singapore
| | - Stan Van Uum
- Department of Medicine, Western University, London, Canada
| | - Tamara Vokes
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Karen K Winer
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Liang Yao
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
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21
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Van Uum S, Shrayyef M, M'Hiri I, Dandurand K, Ali DS, Bilezikian JP, Collins MT, Mannstadt M, Rubin MR, Siggelkow H, Tabacco G, Tay YKD, Vokes T, Winer KK, Yao L, Guyatt G, Rejnmark L, Khan AA. Initial Assessment and Monitoring of Patients with Chronic Hypoparathyroidism: A Systematic Current Practice Survey. J Bone Miner Res 2022; 37:2630-2641. [PMID: 36066096 DOI: 10.1002/jbmr.4698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/26/2022] [Accepted: 08/31/2022] [Indexed: 11/05/2022]
Abstract
Chronic hypoparathyroidism (HypoPT) is associated with significant morbidity and impaired quality of life (QoL). The goals of management for chronic HypoPT include improvement in QoL and the prevention of both hypo- and hypercalcemia symptoms and long-term complications. Several groups have provided consensus statements and guidelines on the management of HypoPT; however, due to limited evidence, these recommendations have largely been based on literature reviews, expert opinion, and consensus statements. The objective of this study was to use a systematic approach to describe current practice for the initial assessment and follow-up of patients with chronic HypoPT. We developed a survey asking experts in the field to select the responses that best reflect their current practice. The survey found no differences in responses between nonsurgical and postsurgical patient assessment. For new patients, respondents usually performed an assessment of serum lab profile (calcium [either albumin-adjusted or ionized], magnesium, creatinine, phosphate, 25-hydroxyvitamin D), 24-hour urine (creatinine, calcium), and a renal ultrasound to evaluate for the presence of nephrocalcinosis or nephrolithiasis. For follow-up patients, most respondents perform blood tests and urine tests every 6 months or less frequently. The reported clinical practice patterns for monitoring for complications of chronic HypoPT vary considerably among respondents. Based on the responses in this systematic expert practice survey, we provide practice suggestions for initial assessment and follow-up of patients with chronic HypoPT. In addition, we highlight areas with significant variation in practice and identify important areas for future research. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Stan Van Uum
- Department of Medicine, Western University, London, ON, Canada
| | | | - Iman M'Hiri
- Bone Research and Education Centre, Oakville, ON, Canada
| | - Karel Dandurand
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, ON, Canada
| | - Dalal S Ali
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, ON, Canada
| | - John P Bilezikian
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Michael T Collins
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - Michael Mannstadt
- Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Mishaela R Rubin
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Heide Siggelkow
- Clinic of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Goettingen, Goettingen, Germany.,MVZ Endokrinologikum Goettingen, Goettingen, Germany
| | - Gaia Tabacco
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | - Yu-Kwang Donovan Tay
- Department of Medicine, Sengkang General Hospital, Singhealth and Duke-NUS Medical School, Singapore, Singapore
| | | | - Karen K Winer
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Liang Yao
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Lars Rejnmark
- Dept of Endocrinology and Internal Medicine, Aarhus University hospital, Aarhus, Denmark
| | - Aliya A Khan
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, ON, Canada
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22
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Yao L, Li J, Li M, Lin C, Hui X, Tamilselvan D, Kandi M, Sreekanta A, Makhdami N, Ali DS, Dandurand K, Yang K, Bilezikian JP, Brandi ML, Clarke BL, Mannstadt M, Rejnmark L, Khan AA, Guyatt G. Parathyroid Hormone Therapy for Managing Chronic Hypoparathyroidism: A Systematic Review and Meta-Analysis. J Bone Miner Res 2022; 37:2654-2662. [PMID: 36385517 DOI: 10.1002/jbmr.4676] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 07/22/2022] [Accepted: 08/08/2022] [Indexed: 01/05/2023]
Abstract
The efficacy and safety of parathyroid hormone (PTH) therapy for managing long-term hypoparathyroidism is being evaluated in ongoing clinical trials. We undertook a systematic review and meta-analysis of currently available randomized controlled trials to investigate the benefits and harms of PTH therapy and conventional therapy in the management of patients with chronic hypoparathyroidism. To identify eligible studies, published in English, we searched Embase, PubMed, and Cochrane CENTRAL from inception to May 2022. Two reviewers independently extracted data and assessed the risk of bias. We defined patients' important outcomes and used grading of recommendations, assessment, development, and evaluation (GRADE) to provide the structure for quantifying absolute effects and rating the quality of evidence. Seven randomized trials of 12 publications that enrolled a total of 386 patients proved eligible. The follow-up duration ranged from 1 to 36 months. Compared with conventional therapy, PTH therapy probably achieves a small improvement in physical health-related quality of life (mean difference [MD] 3.4, 95% confidence interval [CI] 1.5-5.3, minimally important difference 3.0, moderate certainty). PTH therapy results in more patients reaching 50% or greater reduction in the dose of active vitamin D and calcium (relative risk [RR] = 6.5, 95% CI 2.5-16.4, 385 more per 1000 patients, high certainty). PTH therapy may increase hypercalcemia (RR =2.4, 95% CI 1.2-5.04, low certainty). The findings may support the use of PTH therapy in patients with chronic hypoparathyroidism. Because of limitations of short duration and small sample size, evidence from randomized trials is limited regarding important benefits of PTH therapy compared with conventional therapy. Establishing such benefits will require further studies. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Liang Yao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Jing Li
- Evidence-Based Social Sciences Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Meixuan Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Clement Lin
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Xu Hui
- Evidence-Based Social Sciences Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Divyalakshmi Tamilselvan
- Faculty of Health Sciences and Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Canada
| | - Maryam Kandi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Ashwini Sreekanta
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Nima Makhdami
- Department of Internal Medicine, McMaster University, Hamilton, Canada
| | - Dalal S Ali
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada
| | - Karel Dandurand
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada
| | - Kehu Yang
- Evidence-Based Social Sciences Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - John P Bilezikian
- Vagelos College of Physicians and Surgeons, Columbia University, NY, New York City, USA
| | - Maria Luisa Brandi
- Fondazione Italiana sulla Ricerca sulle Malattie dell'Osso (FIRMO Foundation), Florence, Italy
| | - Bart L Clarke
- Division of Endocrinology, Diabetes, Metabolism, and NutritionMayo Clinic, Rochester, MN, USA
| | - Michael Mannstadt
- Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Aliya A Khan
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
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23
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Yao L, Hui X, Li M, Li J, Ahmed MM, Lin C, Kandi M, Sreekanta A, Makhdami N, Tamilselvan D, Ali DS, Dandurand K, Yang K, Bilezikian JP, Brandi ML, Clarke BL, Mannstadt M, Rejnmark L, Khan AA, Guyatt G. Complications, Symptoms, Presurgical Predictors in Patients With Chronic Hypoparathyroidism: A Systematic Review. J Bone Miner Res 2022; 37:2642-2653. [PMID: 36375810 DOI: 10.1002/jbmr.4673] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/22/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022]
Abstract
The complications and symptoms of hypoparathyroidism remain incompletely defined. Measuring serum parathyroid hormone (PTH) and calcium levels early after total thyroidectomy may predict the development of chronic hypoparathyroidism. The study aimed (i) to identify symptoms and complications associated with chronic hypoparathyroidism and determine the prevalence of those symptoms and complications (Part I), and (ii) to examine the utility of early postoperative measurements of PTH and calcium in predicting chronic hypoparathyroidism (Part II). We searched Medline, Medline In-Process, EMBASE, and Cochrane CENTRAL to identify complications and symptoms associated with chronic hypoparathyroidism. We used two predefined criteria (at least three studies reported the complication and symptom and had statistically significantly greater pooled relative estimates). To estimate prevalence, we used the median and interquartile range (IQR) of the studies reporting complications and symptoms. For testing the predictive values of early postoperative measurements of PTH and calcium, we used a bivariate model to perform diagnostic test meta-analysis. In Part I, the 93 eligible studies enrolled a total of 18,973 patients and reported on 170 complications and symptoms. We identified nine most common complications or symptoms probably associated with chronic hypoparathyroidism. The complications or symptoms and the prevalence are as follows: nephrocalcinosis/nephrolithiasis (median prevalence among all studies 15%), renal insufficiency (12%), cataract (17%), seizures (11%), arrhythmia (7%), ischemic heart disease (7%), depression (9%), infection (11%), and all-cause mortality (6%). In Part II, 18 studies with 4325 patients proved eligible. For PTH measurement, regarding the posttest probability, PTH values above 10 pg/mL 12-24 hours postsurgery virtually exclude chronic hypoparathyroidism irrespective of pretest probability (100%). When PTH values are below 10 pg/mL, posttest probabilities range from 3% to 64%. Nine complications and symptoms are probably associated with chronic hypoparathyroidism. A PTH value above a threshold of 10 pg/mL 12-24 hours after total thyroidectomy is a strong predictor that the patients will not develop chronic hypoparathyroidism. Patients with PTH values below the threshold need careful monitoring as some will develop chronic hypoparathyroidism. © 2022 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Liang Yao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Xu Hui
- Evidence-Based Social Sciences Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Meixuan Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Jing Li
- Evidence-Based Social Sciences Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Muhammad Muneeb Ahmed
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Clement Lin
- Faculty of Health Sciences, McMaster University, Canada
| | - Maryam Kandi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ashwini Sreekanta
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Nima Makhdami
- Internal Medicine Resident, Department of Internal Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Divya Tamilselvan
- Faculty of Health Sciences and Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Dalal S Ali
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada
| | - Karel Dandurand
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada
| | - Kehu Yang
- Evidence-Based Social Sciences Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - John P Bilezikian
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Maria Luisa Brandi
- Fondazione Italiana sulla Ricerca sulle Malattie dell'Osso (F.I.R.M.O. Foundation), Florence, Italy
| | - Bart L Clarke
- Mayo Clinic Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Rochester, MN, USA
| | - Michael Mannstadt
- Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Lars Rejnmark
- Dept of Endocrinology and Internal Medicine, Aarhus University hospital, Aarhus, Denmark
| | - Aliya A Khan
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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24
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Bjornsdottir S, Ing S, Mitchell DM, Sikjaer T, Underbjerg L, Hassan-Smith Z, Sfeir J, Gittoes NJ, Clarke L BL. Epidemiology and Financial Burden of Adult Chronic Hypoparathyroidism. J Bone Miner Res 2022; 37:2602-2614. [PMID: 36054571 PMCID: PMC10087725 DOI: 10.1002/jbmr.4675] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/29/2022] [Accepted: 08/07/2022] [Indexed: 11/10/2022]
Abstract
Chronic hypoparathyroidism is characterized by low serum calcium, increased serum phosphorus, and inappropriately low or decreased serum parathyroid hormone. This rare disorder is associated with a variety of complications. The prevalence, incidence, mortality, financial burden, and epidemiology of complications of this disorder are not well understood. This narrative review summarizes current information on the epidemiology and complications of chronic hypoparathyroidism. The reported prevalence of chronic hypoparathyroidism ranges from 6.4-37/100,000, and the incidence is reported to be 0.8-2.3/100,000/year. Mortality is not increased in studies from Denmark or South Korea but was increased in studies from Scotland and Sweden. The financial burden of this disorder is substantial because of increased health care resource utilization in two studies but not well quantitated. Recognized complications include hypercalciuria, nephrocalcinosis, kidney stones, and chronic kidney disease; low bone turnover and possibly upper extremity fractures; cardiac and vascular calcifications; basal ganglia calcifications, cataracts, infections, neuropsychiatric complications, and difficulties with pregnancy. This review concludes that chronic hypoparathyroidism is a rare disorder associated with significant morbidity that may not increase overall mortality but is associated with a substantial financial burden. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
| | - Steven Ing
- Division of Endocrinology, Diabetes and Metabolism, Ohio State University, Columbus, OH, USA
| | - Deborah M Mitchell
- Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Tanja Sikjaer
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Line Underbjerg
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Zaki Hassan-Smith
- Centre for Endocrinology, Diabetes, and Metabolism, Queen Elizabeth Hospital, Birmingham, UK
| | - Jad Sfeir
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Neil J Gittoes
- Centre for Endocrinology, Diabetes, and Metabolism, Queen Elizabeth Hospital, Birmingham, UK
| | - Bart L Clarke L
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
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25
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Khan AA, Bilezikian JP, Brandi ML, Clarke BL, Gittoes NJ, Pasieka JL, Rejnmark L, Shoback DM, Potts JT, Guyatt GH, Mannstadt M. Evaluation and Management of Hypoparathyroidism Summary Statement and Guidelines from the Second International Workshop. J Bone Miner Res 2022; 37:2568-2585. [PMID: 36054621 DOI: 10.1002/jbmr.4691] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 08/18/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022]
Abstract
This clinical practice guideline addresses the prevention, diagnosis, and management of hypoparathyroidism (HypoPT) and provides evidence-based recommendations. The HypoPT task forces included four teams with a total of 50 international experts including representatives from the sponsoring societies. A methodologist (GG) and his team supported the taskforces and conducted the systematic reviews. A formal process following the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology and the systematic reviews provided the structure for seven of the guideline recommendations. The task force used a less structured approach based on narrative reviews for 20 non-GRADEd recommendations. Clinicians may consider postsurgical HypoPT permanent if it persists for >12 months after surgery. To predict which patients will not develop permanent postsurgical HypoPT, we recommend evaluating serum PTH within 12 to 24 hours post total thyroidectomy (strong recommendation, moderate quality evidence). PTH > 10 pg/mL (1.05 pmol/L) virtually excludes long-term HypoPT. In individuals with nonsurgical HypoPT, genetic testing may be helpful in the presence of a positive family history of nonsurgical HypoPT, in the presence of syndromic features, or in individuals younger than 40 years. HypoPT can be associated with complications, including nephrocalcinosis, nephrolithiasis, renal insufficiency, cataracts, seizures, cardiac arrhythmias, ischemic heart disease, depression, and an increased risk of infection. Minimizing complications of HypoPT requires careful evaluation and close monitoring of laboratory indices. In patients with chronic HypoPT, the panel suggests conventional therapy with calcium and active vitamin D metabolites as first-line therapy (weak recommendation, low-quality evidence). When conventional therapy is deemed unsatisfactory, the panel considers the use of PTH. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Aliya A Khan
- Department of Medicine, Division of Endocrinology and Metabolism, McMaster University, Hamilton, ON, Canada
| | - John P Bilezikian
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | | | - Bart L Clarke
- Mayo Clinic Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Rochester, MN, USA
| | - Neil J Gittoes
- Centre for Endocrinology Diabetes & Metabolism, Queen Elizabeth Hospital, Birmingham, UK
| | - Janice L Pasieka
- Department of Surgery and Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Dolores M Shoback
- Endocrine Research Unit, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, CA, USA
| | - John T Potts
- Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Michael Mannstadt
- Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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26
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Sakane EN, Vieira MCC, Vieira GMM, Maeda SS. Treatment options in hypoparathyroidism. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:651-657. [PMID: 36382754 PMCID: PMC10118816 DOI: 10.20945/2359-3997000000554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hypoparathyroidism remains the single endocrine deficiency disease that is not habitually treated with the missing hormone. In this article, we aim to provide a review of the conventional approach and the novel therapies as well as an overview of the perspectives on the treatment of this rare condition. We conducted a literature review on the conventional therapy using vitamin D analogs and calcium salts, indications for thiazide diuretics and phosphorus binders, PTH analogs history and usage, and the drugs that are currently being tested in clinical trials. Conventional treatment involves calcium salts and vitamin D analogs. Thiazide diuretics can be used to reduce hypercalciuria in some cases. A low-phosphate diet is recommended, and phosphate binders are rarely needed. During pregnancy, a careful approach is necessary. The use of PTH analogs is a new approach despite the limitation of high cost. Studies have included modified PTH molecules, calcilytics, microencapsulation of human parathyroid cells, and allotransplantation.
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27
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Clarke BL. Hypoparathyroidism: update of guidelines from the 2022 International Task Force. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:604-610. [PMID: 36382749 PMCID: PMC10118814 DOI: 10.20945/2359-3997000000549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The 2022 International Task Force guidelines for chronic hypoparathyroidism will be published within several months in the Journal of Bone and Mineral Research. These guidelines update the original guidelines published in 2016, and include new information from literature published since then. Chronic postsurgical hypoparathyroidism is now defined as lasting for at least 12 months after surgery, rather than 6 months. Chronic postsurgical hypoparathyroidism may be predicted by serum PTH <10 pg/mL in the first 12-24 hours after surgery. The most common symptoms and complications of chronic hypoparathyroidism based on the literature are summarized in detail. How to monitor and manage patients with hypoparathyroidism is described in detail where recommendations can be given. These guidelines are intended to frame the diagnosis and care of patients with chronic hypoparathyroidism for at least the next five years.
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28
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Kiam JS, Sharma V, Glenister L, Fraser WD, Turner JJO. UK national chronic hypoparathyroidism audit. Clin Endocrinol (Oxf) 2022; 97:562-567. [PMID: 35792134 PMCID: PMC9795987 DOI: 10.1111/cen.14798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/19/2022] [Accepted: 06/23/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Individuals with chronic hypoparathyroidism may experience suboptimal medical care with high frequency of unplanned hospitalisation and iatrogenic harm. In 2015 the European Society for Endocrinology published consensus guidelines on the management of chronic hypoparathyroidism. We set out to audit compliance with these guidelines. METHODS Using these recommendations as audit standards we worked with the Society for Endocrinology and Parathyroid UK to conduct a national audit of management of chronic hypoparathyroidism in the United Kingdom. Endocrine leads in 117 endocrine departments were invited to participate in the survey by completing a data collection tool on up to 5 sequential cases of chronic hypoparathyroidism seen in their outpatient clinics in the preceding 12 months. Data were collected on 4 treatment standards and 9 monitoring standards. Data on hospitalisations and Quality of Life monitoring were also collected. RESULTS Responses were received from 22 departments giving a response rate of 19%, concerning 80 individual cases. The mean age of subjects was 48.4 years. The main findings were that the commonest cause of hypoparathyroidism was post surgical (66.3%). Treatments taken by the group included activated vitamin D analogues (96.3%), oral calcium salts (66.3%), vitamin D supplements (17.5%), thiazide diuretics (5%) and rhPTH1-34 (1.3%). Compliance with the audit standards varied between 98.8% and 60% for the treatment standards and between 91.3% and 20% for the monitoring standards. Some of the areas of weakness revealed include low rates of 24 h urinary calcium excretion monitoring, serum magnesium monitoring and low rates of renal imaging where indicated. In addition and importantly, 16.3% of subjects had experienced at least one hospital admission in the preceding 12 months. CONCLUSION We conclude that further improvements in the UK national standard of management of chronic hypoparathyroidism should be made and that this will benefit both quality of life, morbidity and potentially mortality in this group of patients.
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Affiliation(s)
- Jian Shen Kiam
- Department of Diabetes and EndocrinologyNorfolk and Norwich University HospitalNorwichUK
| | - Vivek Sharma
- Department of Diabetes and EndocrinologyNorfolk and Norwich University HospitalNorwichUK
- Department of Trauma and OrthopaedicsLeicester Royal Infirmary, Infirmary SquareLeicesterUK
| | | | - William D. Fraser
- Department of Diabetes and EndocrinologyNorfolk and Norwich University HospitalNorwichUK
- Faculty of Medicine and Health SciencesNorwich Medical School, University of East Anglia, Norwich Research ParkNorwichUK
| | - Jeremy J. O. Turner
- Department of Diabetes and EndocrinologyNorfolk and Norwich University HospitalNorwichUK
- Faculty of Medicine and Health SciencesNorwich Medical School, University of East Anglia, Norwich Research ParkNorwichUK
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29
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Marcucci G, Beccuti G, Carosi G, Cetani F, Cianferotti L, Colao AM, Di Somma C, Duradoni M, Elefante A, Ghizzoni L, Giusti M, Lania AG, Lavezzi E, Madeo B, Mantovani G, Marcocci C, Masi L, Parri S, Pigliaru F, Santonati A, Spada A, Vera L, Brandi ML. Multicenter retro-prospective observational study on chronic hypoparathyroidism and rhPTH (1-84) treatment. J Endocrinol Invest 2022; 45:1653-1662. [PMID: 35460461 PMCID: PMC9360119 DOI: 10.1007/s40618-022-01800-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/31/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The main purpose of this study was to investigate the effects of 12 months of rhPTH (1-84) (Natpar®) treatment in a cohort of patients selected according to the indications of hypoparathyroidism guidelines. The use of recombinant human PTH (1-84) [rhPTH (1-84)] is approved as hormonal replacement therapy in patients with hypoparathyroidism not adequately controlled with conventional therapy. METHODS It is a multicenter, observational, retro-prospective, open label study. Eleven Italian Endocrinological centers, members of Hypoparathyroidism Working Group of the Italian Society of Endocrinology (HypoparaNET) were involved. Main outcome measures were serum and urinary calcium and phosphate concentration, calcium-phosphate product, renal function, oral calcium and vitamin D doses, and clinical manifestations. RESULTS Fourteen adult subjects, affected by chronic hypoparathyroidism, were treated with rhPTH (1-84) for 12 months. At 12 months of rhPTH (1-84) treatment, 61.5% of patients discontinued calcium supplement and 69.2% calcitriol. Mean albumin-adjusted total serum calcium levels quickly normalized after initiation of rhPTH (1-84) treatment compared to baseline (p = 0.009), remaining in the normal range until 12 months. Rare hypo-hypercalcemia episodes were reported. Renal function was maintained normal and no renal complications were reported. Serum and urinary phosphate and urinary calcium were maintained in the normal range. Mean phosphatemia levels linearly decreased from 3 months up to 12 months compared to baseline (p = 0.014). No severe adverse events were described. CONCLUSIONS Biochemical and clinical results confirm the efficacy and safety of rhPTH (1-84) therapy, which represents an important option for hypoparathyroid patients unresponsive to conventional therapy.
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Affiliation(s)
- G Marcucci
- Bone Metabolic Diseases Unit, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - G Beccuti
- Department of Medical Sciences, Division of Endocrinology, Diabetes and Metabolism, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - G Carosi
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - F Cetani
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - L Cianferotti
- Bone Metabolic Diseases Unit, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - A M Colao
- Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
| | - C Di Somma
- Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
| | - M Duradoni
- Department of Information Engineering, University of Florence, Florence, Italy
| | - A Elefante
- Azienda Ospedaliera Regionale San Carlo, Potenza, Italy
| | - L Ghizzoni
- Department of Medical Sciences, Division of Endocrinology, Diabetes and Metabolism, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - M Giusti
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa, Italy
| | - A G Lania
- Department of Biomedical Sciences, Humanitas University, 20090, Pieve Emanuele, Italy
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center-IRCCS, 20089, Rozzano, Italy
| | - E Lavezzi
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center-IRCCS, 20089, Rozzano, Italy
| | - B Madeo
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
| | - G Mantovani
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - C Marcocci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - L Masi
- AUO-Careggi University Hospital, Florence, Italy
| | - S Parri
- Bone Metabolic Diseases Unit, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - F Pigliaru
- Endocrinology Unit, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - A Santonati
- Department of Endocrinology and Diabetology, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
| | - A Spada
- Department of Endocrinology and Diabetology, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
| | - L Vera
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - M L Brandi
- Fondazione Italiana Di Ricerca Sulle Malattie Dell'osso: F.I.R.M.O, Via San Gallo 123, 50100, Florence, Italy.
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Ayodele O, Mu F, Berman R, Swallow E, Rejnmark L, Gosmanova EO, Kaul S. Lower Risk of Cardiovascular Events in Adult Patients with Chronic Hypoparathyroidism Treated with rhPTH(1-84): A Retrospective Cohort Study. Adv Ther 2022; 39:3845-3856. [PMID: 35696069 PMCID: PMC9309129 DOI: 10.1007/s12325-022-02198-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/17/2022] [Indexed: 11/29/2022]
Abstract
Introduction Patients with chronic hypoparathyroidism are at increased risk of cardiovascular disease. This study evaluated the risk of developing cardiovascular conditions over a period of 5 years in adult patients with chronic hypoparathyroidism treated with recombinant human parathyroid hormone (1–84), rhPTH(1–84), compared with a historical control cohort of patients not treated with rhPTH(1–84). Methods This retrospective cohort study comprised patients with chronic hypoparathyroidism treated with rhPTH(1–84) in the REPLACE (NCT00732615), RELAY (NCT01268098), and RACE (NCT01297309) clinical trials, and controls selected from the IBM® Explorys electronic medical record database (January 2007–August 2019) who did not receive parathyroid hormone but who had enrollment criteria similar to those for the clinical trials. Cardiovascular outcomes were the first diagnosis of cerebrovascular, coronary artery, peripheral vascular disease, or heart failure during the study period. Results We evaluated 113 adult patients with chronic hypoparathyroidism treated with rhPTH(1–84) and 618 control patients who did not receive rhPTH(1–84). Over the 5-year follow-up period, 3.5% of patients (n = 4) in the rhPTH(1–84) cohort had a cardiovascular event compared with 16.3% (n = 101) in the control cohort. Kaplan–Meier analysis demonstrated that patients in the rhPTH(1–84) cohort had lower risk of experiencing a cardiovascular event compared with patients in the control cohort (P = 0.005). Multivariable analyses adjusted for baseline variables showed that patients in the rhPTH(1–84) cohort had 75% lower risk for a cardiovascular event compared with patients in the control cohort (adjusted hazard ratio, 0.25 [95% CI 0.08–0.81]; P = 0.020). Conclusion Long-term treatment with rhPTH(1–84) was associated with a lower risk of incident cardiovascular conditions compared with conventional therapy in patients with chronic hypoparathyroidism. Previous studies demonstrated that mineral homeostasis was maintained with lower use of calcium and active vitamin D when rhPTH(1–84) was added to conventional therapy. Future studies are needed to understand whether improved regulation of mineral homeostasis conferred by rhPTH(1–84) may provide long-term cardiovascular benefits to patients with chronic hypoparathyroidism. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02198-y.
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Affiliation(s)
- Olulade Ayodele
- Takeda Pharmaceuticals USA, Inc., 55 Hayden Ave, Lexington, MA, 02420, USA.
| | - Fan Mu
- Analysis Group, Inc., Boston, MA, USA
| | | | | | - Lars Rejnmark
- Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | | | - Sanjiv Kaul
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
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31
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Arshad MF, Dhami A, Quarrell G, Balasubramanian SP. Parathyroid hormone of ≥1.6 pmol/L at 6 months is associated with recovery in 'long-term' post-surgical hypoparathyroidism. Eur Thyroid J 2022; 11:e210130. [PMID: 35389883 PMCID: PMC9175593 DOI: 10.1530/etj-21-0130] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/05/2022] [Indexed: 11/26/2022] Open
Abstract
Objective Post-surgical hypoparathyroidism (PoSH) usually settles within few months after thyroid surgery, but several patients require long-term supplementation with calcium/activated vitamin D. When PoSH persists beyond 6 months, it is considered 'chronic' or 'permanent', however, late recovery has been reported. The aim of this study was to determine the frequency of late recovery and explore factors predicting late recovery of parathyroid function. Methods Adult patients undergoing total/completion thyroidectomy between 2009 and 2018 were included in this retrospective cohort observational study. The records of patients with evidence of PoSH were reviewed to identify those with persisting PoSH at 6 months. Demographic, biochemical, surgical, pathological, and clinical follow-up data were collected and analysed. Results Out of 911 patients undergoing thyroidectomy, 270 were identified with PoSH. Of these, 192 were started on supplements and 138 (71.9%) recovered within 6 months. Of the remaining 54 patients, 35 had ongoing PoSH with median (range) follow-up of 3.4 (0.5-11.1) years. Nineteen patients were weaned off supplements and achieved remission at median (range) follow-up of 1.3 (0.6-4.8) years. All of those who recovered had a PTH of ≥1.6 pmol/L at 6 months. There was no difference in age, gender, diagnosis, type, and extent of surgery between those who did and did not show late recovery. Conclusions Recovery from PoSH is common beyond 6 months, raising the question whether a 6-month threshold to define 'long-term' PoSH is appropriate. The chances of recovery are high (~50%) in patients with PTH level ≥1.6 pmol/L at 6 months, where attempts at weaning may be focussed.
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Affiliation(s)
- Muhammad Fahad Arshad
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- University of Sheffield, Sheffield, UK
| | - Amardass Dhami
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Gillian Quarrell
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Casale M, Baldini MI, Del Monte P, Gigante A, Grandone A, Origa R, Poggi M, Gadda F, Lai R, Marchetti M, Forni GL. Good Clinical Practice of the Italian Society of Thalassemia and Haemoglobinopathies (SITE) for the Management of Endocrine Complications in Patients with Haemoglobinopathies. J Clin Med 2022; 11:jcm11071826. [PMID: 35407442 PMCID: PMC8999784 DOI: 10.3390/jcm11071826] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 02/01/2023] Open
Abstract
Background: The treatment of endocrinopathies in haemoglobinopathies is a continually expanding research area; therefore, recommendations supporting the appropriateness of treatments are a pressing need for the medical community. Methods: The Management Committee of SITE selected and gathered a multidisciplinary and multi-professional team, including experts in haemoglobinopathies and experts in endocrinopathies, who have been flanked by experts with methodological and organizational expertise, in order to formulate recommendations based on the available scientific evidence integrated by personal clinical experience. The project followed the systematic approach for the production of clinical practice guidelines according to the methodology suggested by the National Center for Clinical Excellence, Quality and Safety of Care (CNEC). Results: Out of 14 topics, 100 clinical questions were addressed, and 206 recommendations were elaborated on. The strength of recommendations, panel agreement, a short general description of the topic, and the interpretation of evidence were reported. Conclusions: Good Practice Recommendations are the final outcome of translational research and allow one to transfer to the daily clinical practice of endocrine complications in haemoglobinopathies.
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Affiliation(s)
- Maddalena Casale
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy;
- Correspondence: ; Tel.: +39-081-566-5432
| | - Marina Itala Baldini
- Centro Malattie Rare, UOC Medicina Interna, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.I.B.); (F.G.)
| | | | - Antonia Gigante
- Società Italiana Talassemie d Emoglobinopatie (SITE), Fondazione per la Ricerca sulle Anemie ed Emoglobinopatie in Italia—For Anemia, 16124 Genoa, Italy;
| | - Anna Grandone
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy;
| | - Raffaella Origa
- SSD Talassemia, Ospedale Pediatrico Microcitemico Cao, Università di Cagliari, 09124 Cagliari, Italy; (R.O.); (R.L.)
| | - Maurizio Poggi
- UOC Endocrinologia, Azienda Ospedaliera Sant’Andrea, 00189 Rome, Italy;
| | - Franco Gadda
- Centro Malattie Rare, UOC Medicina Interna, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.I.B.); (F.G.)
| | - Rosalba Lai
- SSD Talassemia, Ospedale Pediatrico Microcitemico Cao, Università di Cagliari, 09124 Cagliari, Italy; (R.O.); (R.L.)
| | - Monia Marchetti
- Day Service Ematologia, SOC Oncologia, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy;
| | - Gian Luca Forni
- Centro Emoglobinopatie e Anemie Congenite, Ospedali Galliera, 16128 Genoa, Italy;
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Bollerslev J, Rejnmark L, Zahn A, Heck A, Appelman-Dijkstra NM, Cardoso L, Hannan FM, Cetani F, Sikjaer T, Formenti AM, Björnsdottir S, Schalin-Jäntti C, Belaya Z, Gibb F, Lapauw B, Amrein K, Wicke C, Grasemann C, Krebs M, Ryhänen E, Makay Ö, Minisola S, Gaujoux S, Bertocchio JP, Hassan-Smith Z, Linglart A, Winter EM, Kollmann M, Zmierczak HG, Tsourdi E, Pilz S, Siggelkow H, Gittoes N, Marcocci C, Kamenický P. European Expert Consensus on Practical Management of Specific Aspects of Parathyroid Disorders in Adults and in Pregnancy: Recommendations of the ESE Educational Program of Parathyroid Disorders. Eur J Endocrinol 2022; 186:R33-R63. [PMID: 34863037 PMCID: PMC8789028 DOI: 10.1530/eje-21-1044] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/03/2021] [Indexed: 11/17/2022]
Abstract
This European expert consensus statement provides recommendations for the diagnosis and management of primary hyperparathyroidism (PHPT), chronic hypoparathyroidism in adults (HypoPT), and parathyroid disorders in relation to pregnancy and lactation. Specified areas of interest and unmet needs identified by experts at the second ESE Educational Program of Parathyroid Disorders (PARAT) in 2019, were discussed during two virtual workshops in 2021, and subsequently developed by working groups with interest in the specified areas. PHPT is a common endocrine disease. However, its differential diagnosing to familial hypocalciuric hypercalcemia (FHH), the definition and clinical course of normocalcemic PHPT, and the optimal management of its recurrence after surgery represent areas of uncertainty requiring clarifications. HypoPT is an orphan disease characterized by low calcium concentrations due to insufficient PTH secretion, most often secondary to neck surgery. Prevention and prediction of surgical injury to the parathyroid glands are essential to limit the disease-related burden. Long-term treatment modalities including the place for PTH replacement therapy and the optimal biochemical monitoring and imaging surveillance for complications to treatment in chronic HypoPT, need to be refined. The physiological changes in calcium metabolism occurring during pregnancy and lactation modify the clinical presentation and management of parathyroid disorders in these periods of life. Modern interdisciplinary approaches to PHPT and HypoPT in pregnant and lactating women and their newborns children are proposed. The recommendations on clinical management presented here will serve as background for further educational material aimed for a broader clinical audience, and were developed with focus on endocrinologists in training.
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Affiliation(s)
- Jens Bollerslev
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Section of Specialized Endocrinology, Department of Endocrinology, Medical Clinic, Oslo University Hospital, Oslo, Norway
- Correspondence should be addressed to J Bollerslev Email
| | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Alexandra Zahn
- Schön-Klinik Hamburg, Department of Endocrine Surgery, Hamburg, Germany
| | - Ansgar Heck
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Section of Specialized Endocrinology, Department of Endocrinology, Medical Clinic, Oslo University Hospital, Oslo, Norway
| | - Natasha M Appelman-Dijkstra
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Luis Cardoso
- Centro Hospitalar e Universitário de Coimbra, i3S – Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal
| | - Fadil M Hannan
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
| | - Filomena Cetani
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Tanja Sikjaer
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Anna Maria Formenti
- Institute of Endocrine and Metabolic Sciences, Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy
| | - Sigridur Björnsdottir
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
| | - Camilla Schalin-Jäntti
- Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Zhanna Belaya
- The National Medical Research Centre for Endocrinology, Moscow, Russia
| | - Fraser Gibb
- Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Bruno Lapauw
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Karin Amrein
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Corinna Wicke
- Thyroid Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Corinna Grasemann
- Division of Rare Diseases, Department of Pediatrics, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Michael Krebs
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Eeva Ryhänen
- Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Özer Makay
- Division of Endocrine Surgery, Department of General Surgery, Ege University Hospital, Izmir, Turkey
| | - Salvatore Minisola
- Department of Internal Medicine and Medical Disciplines, Sapienza University of Rome, Rome, Italy
| | - Sébastien Gaujoux
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Paris Descartes University, Cochin Hospital, Paris, France
| | - Jean-Philippe Bertocchio
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Nephrology Department, Boulevard de l’Hôpital, Paris, France
| | - Zaki Hassan-Smith
- Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Agnès Linglart
- Université de Paris Saclay, AP-HP, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphate, Filière OSCAR, Service d’Endocrinologie et Diabète de l’Enfant, Hôpital Bicêtre Paris Saclay, Le Kremlin Bicêtre, France
| | - Elizabeth M Winter
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Martina Kollmann
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Hans-Georg Zmierczak
- Reference Centre for Rare Bone, Calcium and Phosphate Disorders – University Hospital Ghent, Ghent, Belgium
| | - Elena Tsourdi
- Center for Healthy Aging, Department of Medicine III, Technische Universität Dresden Medical Center, Dresden, Germany
| | - Stefan Pilz
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Heide Siggelkow
- Endokrinologikum Göttingen, Georg-August-University Göttingen, Göttingen, Germany
| | - Neil Gittoes
- Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Claudio Marcocci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Peter Kamenický
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphate, Le Kremlin-Bicêtre, France
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Konca Degertekin C, Gogas Yavuz D, Pekkolay Z, Saygili E, Ugur K, Or Koca A, Unubol M, Topaloglu O, Aydogan BI, Ozdemir Kutbay N, Hekimsoy Z, Yilmaz N, Balci MK, Tanrikulu S, Aydogan Unsal Y, Ersoy C, Omma T, Keskin M, Yalcin MM, Yetkin I, Soylu H, Karakose M, Yilmaz M, Karakilic E, Piskinpasa H, Batman A, Akbaba G, Elbuken G, Tura Bahadir C, Kilinc F, Bilginer MC, Turhan Iyidir O, Canturk Z, Aktas Yilmaz B, Sayiner ZA, Eroglu M. Identifying Clinical Characteristics of Hypoparathyroidism in Turkey: HIPOPARATURK-NET Study. Calcif Tissue Int 2022; 110:204-214. [PMID: 34495356 DOI: 10.1007/s00223-021-00908-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/20/2021] [Indexed: 12/19/2022]
Abstract
Hypoparathyroidism is an orphan disease with ill-defined epidemiology that is subject to geographic variability. We conducted this study to assess the demographics, etiologic distribution, treatment patterns and complication frequency of patients with chronic hypoparathyroidism in Turkey. This is a retrospective, cross-sectional database study, with collaboration of 30 endocrinology centers located in 20 cities across seven geographical regions of Turkey. A total of 830 adults (mean age 49.6 ± 13.5 years; female 81.2%) with hypoparathyroidism (mean duration 9.7 ± 9.0 years) were included in the final analysis. Hypoparathyroidism was predominantly surgery-induced (n = 686, 82.6%). The insulting surgeries was carried out mostly due to benign causes in postsurgical group (SG) (n = 504, 73.5%) while patients in nonsurgical group (NSG) was most frequently classified as idiopathic (n = 103, 71.5%). The treatment was highly dependent on calcium salts (n = 771, 92.9%), calcitriol (n = 786, 94.7%) and to a lower extent cholecalciferol use (n = 635, 76.5%) while the rate of parathyroid hormone (n = 2, 0.2%) use was low. Serum calcium levels were most frequently kept in the normal range (sCa 8.5-10.5 mg/dL, n = 383, 46.1%) which might be higher than desired for this patient group. NSG had a lower mean plasma PTH concentration (6.42 ± 5.53 vs. 9.09 ± 7.08 ng/l, p < 0.0001), higher daily intake of elementary calcium (2038 ± 1214 vs. 1846 ± 1355 mg/day, p = 0.0193) and calcitriol (0.78 ± 0.39 vs. 0.69 ± 0.38 mcg/day, p = 0.0057), a higher rate of chronic renal disease (9.7% vs. 3.6%, p = 0.0017), epilepsy (6.3% vs. 1.6%, p = 0.0009), intracranial calcifications (11.8% vs. 7.3%, p < 0.0001) and cataracts (22.2% vs. 13.7%, p = 0.0096) compared to SG. In conclusion, postsurgical hypoparathyroidism is the dominant etiology of hypoparathyroidism in Turkey while the nonsurgical patients have a higher disease burden with greater need for medications and increased risk of complications than the postsurgical patients.
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Affiliation(s)
- Ceyla Konca Degertekin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ufuk University, Ankara, Turkey.
- Endokrinoloji BD, Ufuk Üniversitesi Hastanesi, Mevlana Bulvarı (Konya Yolu) No:86-88 Balgat, Ankara, Turkey.
| | - Dilek Gogas Yavuz
- Department of Endocrinology and Metabolism, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Zafer Pekkolay
- Department of Endocrinology and Metabolism, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Emre Saygili
- Endocrinology and Metabolism Clinic, Canakkale Mehmet Akif Ersoy State Hospital, Canakkale, Turkey
| | - Kader Ugur
- Department of Endocrinology and Metabolism, Faculty of Medicine, Fırat University, Elazig, Turkey
| | - Arzu Or Koca
- Endocrinology and Metabolism Clinic, Kecioren Training and Research Hospital, Ankara, Turkey
| | - Mustafa Unubol
- Department of Endocrinology and Metabolism, Faculty of Medicine, Aydın Adnan Menderes University, Aydin, Turkey
| | - Omercan Topaloglu
- Endocrinology and Metabolism Clinic, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Berna Imge Aydogan
- Endocrinology and Metabolism Clinic, Batman Training and Research Hospital, Batman, Turkey
| | - Nilufer Ozdemir Kutbay
- Department of Endocrinology and Metabolism, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Zeliha Hekimsoy
- Department of Endocrinology and Metabolism, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Nusret Yilmaz
- Department of Endocrinology and Metabolism, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Mustafa Kemal Balci
- Department of Endocrinology and Metabolism, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Seher Tanrikulu
- Endocrinology and Metabolism Clinic, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Yasemin Aydogan Unsal
- Department of Endocrinology and Metabolism, Faculty of Medicine, Bursa Uludağ University, Bursa, Turkey
| | - Canan Ersoy
- Department of Endocrinology and Metabolism, Faculty of Medicine, Bursa Uludağ University, Bursa, Turkey
| | - Tulay Omma
- Endocrinology and Metabolism Clinic, Ankara Training and Research Hospital, Ankara, Turkey
| | - Muge Keskin
- Endocrinology and Metabolism Clinic, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Mehmet Muhittin Yalcin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ilhan Yetkin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Hikmet Soylu
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kırsehir Ahi Evran University, Kirsehir, Turkey
| | - Melia Karakose
- Department of Endocrinology and Metabolism, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Merve Yilmaz
- Endocrinology and Metabolism Clinic, Samsun Gazi Training and Research Hospital, Samsun, Turkey
| | - Ersen Karakilic
- Department of Endocrinology and Metabolism, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Hamide Piskinpasa
- Endocrinology and Metabolism Clinic, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Adnan Batman
- Endocrinology and Metabolism Clinic, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Gulhan Akbaba
- Department of Endocrinology and Metabolism, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Gulsah Elbuken
- Department of Endocrinology and Metabolism, Faculty of Medicine, Tekirdag Namık Kemal University, Tekirdag, Turkey
| | - Cigdem Tura Bahadir
- Department of Endocrinology and Metabolism, Faculty of Medicine, Amasya University, Amasya, Turkey
| | - Faruk Kilinc
- Department of Endocrinology and Metabolism, Faculty of Medicine, Fırat University, Elazig, Turkey
| | - Muhammet Cuneyt Bilginer
- Endocrinology and Metabolism Clinic, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Ozlem Turhan Iyidir
- Department of Endocrinology and Metabolism, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Zeynep Canturk
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Banu Aktas Yilmaz
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ufuk University, Ankara, Turkey
| | - Zeynel Abidin Sayiner
- Department of Endocrinology and Metabolism, Faculty of Medicine, Nigde University, Nigde, Turkey
| | - Mustafa Eroglu
- Department of Endocrinology and Metabolism, Faculty of Medicine, Balıkesir University, Balikesir, Turkey
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Bertocchio JP, Grosset N, Groussin L, Kamenický P, Larceneux F, Lienhardt-Roussie A, Linglart A, Maruani G, Mirallie E, Pattou F, Seervai RNH, Sido C, Silve C, Vilfaillot A, Tabarin A, Vantyghem MC, Houillier P. Practice patterns for chronic hypoparathyroidism: data from patients and physicians in France. Endocr Connect 2022; 11:EC-21-0350.R2. [PMID: 34939939 PMCID: PMC8859964 DOI: 10.1530/ec-21-0350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 12/23/2021] [Indexed: 11/28/2022]
Abstract
CONTEXT Recent guidelines have provided recommendations for the care of patients with chronic hypoparathyroidism. Very little is known about actual physicians' practices or their adherence to such guidelines. OBJECTIVE To describe the physicians' practice patterns and their compliance with international guidelines. DESIGN The cohort studies included were Épi-Hypo (118 physicians and 107 patients, from September 2016 to December 2019) and ePatients (110 patients, November 2019). METHODS Internet-based cohorts involving all settings at a nationwide level (France). Participants were (i) physicians treating patients with chronic hypoparathyroidism and patients with chronic hypoparathyroidism either participating in the (ii) Épi-Hypo study (Épi-Hypo 2019 patients), or (iii) Hypoparathyroidism France, the national representative association (ePatients). RESULTS The physicians' specialties were mainly endocrinology (61%), nephrology (28%), family medicine (2.5%), pediatrics (2.5%), rheumatology (2%), or miscellaneous (4%) and 45% were practicing in public universities. The median number of pharmaceutical drug classes prescribed was three per patient. The combination of active vitamin D and calcium salt was given to 59 and 58% of ePatients and Épi-Hypo 2019 patients, respectively. Eighty-five percent of ePatients and 87% of physicians reported monitoring plasma calcium concentrations at a steady state at least twice a year. In 32 and 26% of cases, respectively, ePatients and physicians reported being fully in accordance with international guidelines that recommend targeting symptoms, plasma calcium and phosphate values, and urine calcium excretion. CONCLUSIONS The care of patients with chronic hypoparathyroidism involves physicians with very different practices, so guidelines should include and target other specialists as well as endocrinologists. Full adherence to the guidelines is low in France.
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Affiliation(s)
- Jean-Philippe Bertocchio
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Physiologie, Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphore Filière de Santé Maladies Rares OSCAR, Paris, France
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, INSERM, UMRS1138, Paris, France
- Correspondence should be addressed to J-P Bertocchio or P Houillier: or
| | | | - Lionel Groussin
- Department of Endocrinology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Université de Paris, Paris, France
| | - Peter Kamenický
- Université Paris-Saclay, Inserm U1185, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphate, Le Kremlin-Bicêtre, France
| | - Fabrice Larceneux
- Université Paris-Dauphine, PSL Research University, CNRS, UMR 7088, DRM [Ermes], Paris, France
| | | | - Agnès Linglart
- Centre de Référence des Maladies Rares du Calcium et du Phosphore Filière de Santé Maladies Rares OSCAR, Paris, France
- Université Paris-Saclay, Inserm U1185, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Service d’Endocrinologie et Diabète de l’Enfant, Centre de Référence des Maladies Rares du Calcium et du Phosphore et Filière de Santé Maladies Rares OSCAR, Hôpital Bicêtre Paris Saclay, Le Kremlin-Bicêtre, France
| | - Gérard Maruani
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Physiologie, Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphore Filière de Santé Maladies Rares OSCAR, Paris, France
- Assistance Publique-Hôpitaux de Paris, Institut Necker-Enfants Malades, INSERM U1151 – CNRS UMR 8253, Paris, France
| | - Eric Mirallie
- Chirurgie Cancérologique, Digestive et Endocrine, Institut des Maladies de l’Appareil Digestif, Hôtel Dieu, CHU Nantes, France
- Association Francophone de Chirurgie Endocrinienne (AFCE), France
| | - François Pattou
- Université de Lille, CHU Lille, Institut Pasteur Lille, Inserm U1190, Lille, France
| | - Riyad N H Seervai
- Molecular & Cellular Biology Graduate Program, Medical Scientist Training Program, Baylor College of Medicine, Houston, Texas, USA
| | | | - Caroline Silve
- Centre de Référence des Maladies Rares du Calcium et du Phosphore Filière de Santé Maladies Rares OSCAR, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Biochimie et Génétique Moléculaires, Paris, France
- INSERM, U1169, Université Paris Sud, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Aurélie Vilfaillot
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Unité de Recherche Clinique, Paris, France
- INSERM, U1418, CIC-EC, Hôpital Européen Georges Pompidou, Paris, France
| | - Antoine Tabarin
- Service Endocrinologie Diabète et Nutrition, CHU de Bordeaux, Université de Bordeaux, Pessac, France
| | - Marie-Christine Vantyghem
- CHU Lille, Department of Endocrinology, Diabetology and Metabolism, Inserm U1190, EGID, Lille, France
| | - Pascal Houillier
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Physiologie, Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphore Filière de Santé Maladies Rares OSCAR, Paris, France
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, INSERM, UMRS1138, Paris, France
- CNRS, ERL8228, Paris, France
- Correspondence should be addressed to J-P Bertocchio or P Houillier: or
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Bilginer MC, Aydin C, Polat B, Faki S, Topaloglu O, Ersoy R, Cakir B. Assessment of calcium and vitamin D medications adherence in patients with hypoparathyroidism after thyroidectomy. Arch Osteoporos 2022; 17:22. [PMID: 35072832 DOI: 10.1007/s11657-022-01066-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/18/2022] [Indexed: 02/03/2023]
Abstract
In this study, we found that patients with hypoparathyroidism had a problem with calcium medication compliance, and this problem increased with the duration of the disease. We also showed that patients are concerned about the possible side effects of drugs. INTRODUCTION In this study, we aimed to evaluate adherence to active vitamin D and calcium replacement in patients with post-surgical hypoparathyroidism. METHODS To elucidate the medication adherence, we performed a questionnaire survey using the six-item "Medication adherence questionnaire"(MAQ). The first, second, and sixth questions reflect the motivation status of the patients whereas the third, fourth, and fifth questions reflect the knowledge about the medication that is received. The responses are scored and patients are classified regarding their motivation to and knowledge about the particular drug. RESULTS Totally, 64 patients (male: 12/female: 52; mean age 48.6±11.6 years) who had post-operative hypoparathyroidism were included in our study. Median disease durance was 60 months (min-max: 12-295 months). We found that motivation score of calcium usage was significantly lower compared to vitamin D usage (p<0.001). The calcium motivation score was reversely correlated with disease duration (r= -0.256 and p=0.046). The most common worry about calcium usage was nephrotoxicity, and the most common worries about calcitriol treatment were kidney damage and polyuria. One-third of the patients were taking oral calcium and calcitriol less than the recommended dose. CONCLUSION One-third of patients lack motivation to use calcium whereas half of the patients experiences anxiety about drug-related side effects. This is a preliminary study showing that vital calcium and active vitamin D intake may be interrupted due to side effect anxiety.
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Affiliation(s)
- Muhammet Cuneyt Bilginer
- Faculty of Medicine, Department of Endocrinology and Metabolism, Karadeniz Technical University, Trabzon, Turkey.
| | - Cevdet Aydin
- Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Burcak Polat
- Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Sevgul Faki
- Department of Endocrinology and Metabolism, University of Health Sciences Turkey, Ankara City Hospital, Ankara, Turkey
| | - Oya Topaloglu
- Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Reyhan Ersoy
- Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Bekir Cakir
- Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara Yıldırım Beyazıt University, Ankara, Turkey
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Gosmanova EO, Ayodele O, Chen K, Cook EE, Mu F, Young JA, Rejnmark L. Association of Calcium and Phosphate Levels with Incident Chronic Kidney Disease in Patients with Hypoparathyroidism: A Retrospective Case-Control Study. Int J Endocrinol 2022; 2022:6078881. [PMID: 36389126 PMCID: PMC9646300 DOI: 10.1155/2022/6078881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 07/14/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Reasons for the increased incidence of chronic kidney disease (CKD) in patients with chronic hypoparathyroidism are poorly understood. This study evaluated associations between levels of albumin-corrected serum calcium, serum phosphate, and calcium-phosphate product and the odds of CKD development in patients with chronic hypoparathyroidism. DESIGN A retrospective nested case-control study of adult patients with chronic hypoparathyroidism who had ≥1 prescription for calcitriol who developed CKD and matched controls who did not develop CKD were selected from the IBM® Explorys electronic medical record database. Patients. The study included a cohort of 300 patients for the albumin-corrected serum calcium analysis and 80 patients for the serum phosphate and calcium-phosphate product analyses. Measurements. We examined associations between albumin-corrected serum calcium, serum phosphate and calcium-phosphate product levels, and the risk of devloping CKD (defined as ≥2 outpatient estimated glomerular filtration values <60 mL/min/1.73 m2 occuring ≥3 months apart or ≥1 diagnostic code for CKD stages 3-5). RESULTS Individuals who had ≥67% of albumin-corrected serum calcium measurements outside, above, or below the study-defined range (2.00-2.25 mmol/L [8.0-9.0 mg/dL]) had 3.5-, 2.9-, and 2.7-fold higher odds of developing CKD (adjusted odds ratios [95% CI]: 3.46 [1.82-6.56], 2.85 [1.30-6.28], and 2.68 [1.16-6.15]), respectively, compared with patients who had <33% of albumin-corrected calcium measurements in those ranges. There was no association between developing CKD and having any serum phosphate measurements or any calcium-phosphate product measurements above normal population ranges. CONCLUSION In adult patients with chronic hypoparathyroidism, a higher proportion of albumin-corrected calcium measurements outside of the 2.00-2.25 mmol/L (8.0-9.0 mg/dL) range was associated with higher odds of developing CKD.
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Affiliation(s)
| | | | - Kristina Chen
- Takeda Pharmaceuticals USA, Inc., Lexington, MA, USA
| | | | - Fan Mu
- Analysis Group, Inc., Boston, MA, USA
| | | | - Lars Rejnmark
- Aarhus University and Aarhus University Hospital, Aarhus, Denmark
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Ayodele O, Rejnmark L, Mu F, Lax A, Berman R, Swallow E, Gosmanova EO. Five-Year Estimated Glomerular Filtration Rate in Adults with Chronic Hypoparathyroidism Treated with rhPTH(1-84): A Retrospective Cohort Study. Adv Ther 2022; 39:5013-5024. [PMID: 36018496 PMCID: PMC9525348 DOI: 10.1007/s12325-022-02292-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/01/2022] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Chronic hypoparathyroidism is associated with higher risk of developing chronic kidney disease compared with the general population. This study evaluated changes in estimated glomerular filtration rate (eGFR) over a 5-year period in adult patients with chronic hypoparathyroidism treated with recombinant parathyroid hormone (1-84), rhPTH(1-84), compared with a historical control cohort of patients who did not receive rhPTH(1-84). METHODS This retrospective cohort study included patients with chronic hypoparathyroidism treated with rhPTH(1-84) in the REPLACE (NCT00732615), RELAY (NCT01268098), RACE (NCT01297309), and HEXT (NCT01199614 and continuation study NCT02910466) clinical trials. A historical control cohort who did not receive parathyroid hormone but who had enrollment criteria similar to those for the clinical trials was selected from the IBM® Explorys electronic medical record database (January 2007-August 2019). Outcomes of interest were the annual rate of change in eGFR from baseline (i.e., eGFR slope) and the predicted eGFR change from baseline at years 1 through 5. RESULTS The study comprised 72 adult patients with chronic hypoparathyroidism treated with rhPTH(1-84) and 176 control patients who did not receive rhPTH(1-84). Over 5 years, eGFR remained stable in the rhPTH(1-84) cohort, whereas eGFR declined at a rate of 1.67 mL/min/1.73 m2 per year in the control cohort (P < 0.001 for eGFR slope in the control cohort). At 5 years, predicted eGFR in the rhPTH(1-84) cohort increased from baseline by 1.21 mL/min/1.73 m2, whereas eGFR in the control cohort declined by 10.36 mL/min/1.73 m2, after adjusting for baseline variables. The difference in eGFR slopes between the cohorts over 5 years was 1.37 mL/min/1.73 m2 per year (95% CI 0.62-2.13; P < 0.001). CONCLUSION Long-term treatment with rhPTH(1-84) was associated with stable eGFR compared with eGFR decline in the controls not treated with rhPTH(1-84). Preservation of renal function conferred by rhPTH(1-84) may benefit patients with chronic hypoparathyroidism by reducing risk of long-term renal complications.
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Affiliation(s)
- Olulade Ayodele
- grid.419849.90000 0004 0447 7762Takeda Pharmaceuticals USA, Inc., 55 Hayden Ave, Lexington, MA 02420 USA
| | - Lars Rejnmark
- grid.7048.b0000 0001 1956 2722Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Fan Mu
- grid.417986.50000 0004 4660 9516Analysis Group, Inc., Boston, MA USA
| | - Angela Lax
- grid.417986.50000 0004 4660 9516Analysis Group, Inc., Boston, MA USA
| | - Richard Berman
- grid.417986.50000 0004 4660 9516Analysis Group, Inc., Boston, MA USA
| | - Elyse Swallow
- grid.417986.50000 0004 4660 9516Analysis Group, Inc., Boston, MA USA
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Gittoes N, Rejnmark L, Ing SW, Brandi ML, Björnsdottir S, Hahner S, Hofbauer LC, Houillier P, Khan AA, Levine MA, Mannstadt M, Shoback DM, Vokes TJ, Zhang P, Marelli C, Germak J, Clarke BL. The PARADIGHM (physicians advancing disease knowledge in hypoparathyroidism) registry for patients with chronic hypoparathyroidism: study protocol and interim baseline patient characteristics. BMC Endocr Disord 2021; 21:232. [PMID: 34801015 PMCID: PMC8606089 DOI: 10.1186/s12902-021-00888-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 10/26/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The PARADIGHM registry of adult and pediatric patients with chronic hypoparathyroidism evaluates the long-term safety and effectiveness of treatment with recombinant human parathyroid hormone, rhPTH(1-84), and describes the clinical disease course under conditions of routine clinical practice. In this first report, we detail the registry protocol and describe the baseline characteristics of two adult patient cohorts from an interim database analysis. One cohort after study entry were prescribed rhPTH(1-84), and the other cohort received conventional therapy of calcium and active vitamin D. METHODS An observational study of patients with chronic hypoparathyroidism in North America and Europe, collecting data for ≥10 years per patient. Main outcome measures were baseline patient demographics, clinical characteristics, medications, and disease outcome variables of symptoms, biochemical parameters, and health assessments. Baseline is the enrollment assessment for all variables except biochemical measurements in patients treated with rhPTH(1-84); those measurements were the most recent value before the first rhPTH(1-84) dose. Exclusion criteria applied to the analysis of specified outcomes included pediatric patients, patients who initiated rhPTH(1-84) prior to enrollment, and those who received rhPTH(1-34). Clinically implausible biochemical outlier data were excluded. RESULTS As of 30 June 2019, data of 737 patients were analyzed from 64 centers; 587 (80%) were women, mean ± SD age 49.1±16.45 years. At enrollment, symptoms reported for patients later prescribed rhPTH(1-84) (n=60) and those who received conventional therapy (n=571), respectively, included fatigue (51.7%, 40.1%), paresthesia (51.7%, 29.6%), muscle twitching (48.3%, 21.9%), and muscle cramping (41.7%, 33.8%). Mean serum total calcium, serum phosphate, creatinine, and estimated glomerular filtration rate were similar between cohorts. Health-related quality of life (HRQoL) 36-item Short Form Health Survey questionnaire scores for those later prescribed rhPTH(1-84) were generally lower than those for patients in the conventional therapy cohort. CONCLUSIONS At enrollment, based on symptoms and HRQoL, a greater percentage of patients subsequently prescribed rhPTH(1-84) appeared to have an increased burden of disease than those who received conventional therapy despite having normal biochemistry measurements. PARADIGHM will provide valuable real-world insights on the clinical course of hypoparathyroidism in patients treated with rhPTH(1-84) or conventional therapy in routine clinical practice. TRIAL REGISTRATION EUPAS16927, NCT01922440.
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Affiliation(s)
- Neil Gittoes
- Centre for Endocrinology, Diabetes and Metabolism (CEDAM), Queen Elizabeth Hospital Edgbaston, 3rd Floor, Heritage Building, Birmingham, B15 2TH, UK.
| | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Steven W Ing
- Division of Endocrinology, Diabetes and Metabolism, 547 McCampbell Hall, Ohio State University Wexner Medical Center, 1581 Dodd Drive, Columbus, OH, 43210, USA
| | - Maria Luisa Brandi
- Endocrinology and Metabolic Diseases, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - Sigridur Björnsdottir
- Department of Endocrinology, Metabolism, and Diabetes, Karolinska University Hospital Solna, SE-17176, Stockholm, Sweden
| | - Stefanie Hahner
- Department of Medicine I Endocrinology, and Diabetology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Lorenz C Hofbauer
- Division of Endocrinology, Diabetes, and Bone Diseases, Technische Universität Dresden Medical Center, Fetscherstrasse 74, D-01307, Dresden, Germany
| | - Pascal Houillier
- Centre de Recherche des Cordeliers, INSERM, 15 Rue de l'Ecole de Médecine, Sorbonne Université, Université de Paris, Assistance Publique-Hôpitaux de Paris, 75006, Paris, France
| | - Aliya A Khan
- Department of Medicine, McMaster University, 3075 Hospital Gate, Oakville, ON, L6M 1M1, Canada
| | - Michael A Levine
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Michael Mannstadt
- Endocrine Unit Massachusetts General Hospital and Harvard Medical School, 50 Blossom Street, Boston, MA, 02114, USA
| | - Dolores M Shoback
- Endocrine Research Unit, San Francisco Department of Veterans Affairs Medical Center and University of California, 1700 Owens Street, San Francisco, CA, 94158, USA
| | - Tamara J Vokes
- Section of Endocrinology, University of Chicago Medicine, 5841 South Maryland Avenue, Chicago, IL, 60637, USA
| | - Pinggao Zhang
- Shire Human Genetic Therapies, Inc., a Takeda company, 45 Hayden Ave, Lexington, MA, 02421, USA
| | - Claudio Marelli
- Takeda Pharmaceuticals International AG, Thurgauerstrasse 130, 8152 Glattpark-Opfikon, Zurich, Switzerland
| | - John Germak
- Shire Human Genetic Therapies, Inc., a Takeda company, 45 Hayden Ave, Lexington, MA, 02421, USA
| | - Bart L Clarke
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, 1st Street SW, Rochester, MN, USA
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Marcucci G, Altieri P, Benvenga S, Bondanelli M, Camozzi V, Cetani F, Cianferotti L, Duradoni M, Fossi C, Degli Uberti E, Famà F, Mantovani G, Marcocci C, Masi L, Pagotto U, Palermo A, Parri S, Ruggeri RM, Zatelli MC, Brandi ML. Hypoparathyroidism and pseudohypoparathyroidism in pregnancy: an Italian retrospective observational study. Orphanet J Rare Dis 2021; 16:421. [PMID: 34627337 PMCID: PMC8501695 DOI: 10.1186/s13023-021-02053-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 09/20/2021] [Indexed: 12/01/2022] Open
Abstract
Background Hypoparathyroidism (HypoPT) or pseudo-hypoparathyroidism (pseudo-HypoPT) during pregnancy may cause maternal and fetal/neonatal complications. In this regard, only a few case reports or case series of pregnant or lactating women have been published. The purpose of this study was to describe clinical and biochemical course, pharmacological management, and potential adverse events during pregnancy and post-partum in pregnant women with HypoPT or pseudo-HypoPT. This was a retrospective, observational, multicenter, study involving nine Italian referral centers for endocrine diseases affiliated with the Italian Society of Endocrinology and involved in “Hypoparathyroidism Working Group”. Results This study identified a cohort of 28 women (followed between 2005 and 2018) with HypoPT (n = 25, 84% postsurgical, 16% idiopathic/autoimmune) and pseudo-HypoPT (n = 3). In HypoPT women, the mean calcium carbonate dose tended to increase gradually from the first to third trimester (+ 12.6%) in pregnancy. This average increase in the third trimester was significantly greater compared to the pre-pregnancy period (p value = 0.03). However, analyzing the individual cases, in 44% the mean calcium dosage remained unchanged throughout gestation. Mean calcitriol doses tended to increase during pregnancy, with a statistically significant increase between the third trimester and the pre-pregnancy period (p value = 0.02). Nevertheless, analyzing the individual cases, in the third trimester most women with HypoPT (64%) maintained the same dosage of calcitriol compared to the first trimester. Both mean calcium carbonate and calcitriol doses tended to decrease from the third trimester to the post-partum six months. Most identified women (~ 70%) did not display maternal complications and (~ 90%) maintained mean serum albumin-corrected total calcium levels within the low-to-mid normal reference range (8.5 ± 0.8 mg/dl) during pregnancy. The main complications related to pregnancy period included: preterm birth (n = 3 HypoPT women), and history of miscarriages (n = 6 HypoPT women and n = 2 pseudo-HypoPT women). Conclusion This study shows that mean serum albumin-corrected total calcium levels were carefully monitored during pregnancy and post-pregnancy, with limited evaluation of other biochemical parameters, such as serum phosphate, 24 h urinary calcium, 25-OH vitamin D, and creatinine clearance. To avoid complications in mothers affected by (HypoPT) or (pseudo-HypoPT) and offspring, intense biochemical, clinical and pharmacological monitoring during pregnancy and breastfeeding is highly recommended.
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Affiliation(s)
- Gemma Marcucci
- Bone Metabolic Diseases Unit, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - Paola Altieri
- Endocrinology Unit and Prevention and Care of Diabetes, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Marta Bondanelli
- Department of Medical Sciences, Section of Endocrinology and Internal Medicine, University of Ferrara, Ferrara, Italy
| | - Valentina Camozzi
- Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Filomena Cetani
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luisella Cianferotti
- Bone Metabolic Diseases Unit, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - Mirko Duradoni
- Department of Information Engineering, University of Florence, Florence, Italy
| | - Caterina Fossi
- Bone Metabolic Diseases Unit, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - Ettore Degli Uberti
- Department of Medical Sciences, Section of Endocrinology and Internal Medicine, University of Ferrara, Ferrara, Italy
| | - Fausto Famà
- Division of Endocrine and Minimally Invasive Surgery Department of Human Pathology in Adulthood and Childhood "G. Barresi",, University Hospital "G. Martino" of Messina, Messina, Italy
| | - Giovanna Mantovani
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Claudio Marcocci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Laura Masi
- Bone Metabolic Diseases Unit, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - Uberto Pagotto
- Endocrinology Unit and Prevention and Care of Diabetes, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Andrea Palermo
- Unit of Endocrinology, Campus Bio-Medico University, Rome, Italy
| | - Simone Parri
- Bone Metabolic Diseases Unit, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - Rosaria Maddalena Ruggeri
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Messina, Messina, Italy
| | - Maria Chiara Zatelli
- Department of Medical Sciences, Section of Endocrinology and Internal Medicine, University of Ferrara, Ferrara, Italy
| | - Maria Luisa Brandi
- Bone Metabolic Diseases Unit, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy.
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Midha NK, Garg MK, Kumar D, Meena DS, Bohra GK. Rapidly Developing Cataract in Young Adult Patients: Always a Matter for Further Evaluation. Cureus 2021; 13:e17312. [PMID: 34557362 PMCID: PMC8449744 DOI: 10.7759/cureus.17312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 11/25/2022] Open
Abstract
A cataract in the young age group is uncommon and it is usually secondary to eye trauma, intraocular inflammation, uncontrolled diabetes mellitus, and hypoparathyroidism. We report a case of a rapidly developing cataract over two years in a 21-year-old female with extensive intracranial calcification due to primary hypoparathyroidism. Chronic hypocalcemia due to underlying hypoparathyroidism results in cataract. Extensive bilateral intracranial calcification involving basal ganglia and white matter has been rarely reported in the literature. It occurs due to the chronic deposition of calcium-phosphorus complexes. We would like to highlight that cataract in young patients is always a matter for further evaluation. Clinicians and ophthalmologists should be aware of hypoparathyroidism as a cause of bilateral cataracts. Early diagnosis of primary hypoparathyroidism can save patients from many complications.
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Affiliation(s)
- Naresh K Midha
- Medicine, All India Institute of Medical Sciences, Jodhpur, IND
| | | | - Deepak Kumar
- Medicine, All India Institute of Medical Sciences, Jodhpur, IND
| | | | - Gopal K Bohra
- Medicine, All India Institute of Medical Sciences, Jodhpur, IND
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Mokrysheva NG, Kovaleva EV, Eremkina AK. [Registries of parathyroid glands diseases in the Russian Federation]. ACTA ACUST UNITED AC 2021; 67:4-7. [PMID: 34533008 DOI: 10.14341/probl12803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 11/06/2022]
Abstract
The most important and effective way to organize nationwide the healthcare, as well as monitoring and routing for patients with endocrine diseases, is the creation of an unified medical record (Endocard). The Endocard is also aimed at maximizing the opportunity for professionals and researchers on various scientific issues. Registries are the potential informational and analytical platform to achieve this goal. They include the basic information on the epidemiological and clinical features of the most severe diseases such as diabetes mellitus. Given the lack of large-scale epidemiological data on the parathyroid glands pathology - primary hyperparathyroidism and hypoparathyroidism - the registers of these diseases that collects a common dataset and clinician and patient reported outcomes are of particular interest.
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Kovaleva EV, Eremkina AK, Krupinova JA, Mirnaya SS, Kim IV, Kuznetzov NS, Andreeva EN, Karonova TL, Kryukova IV, Mudunov AM, Sleptcov IV, Melnichenko GA, Mokrysheva NG, Dedov II. [Review of clinical practice guidelines for hypoparathyroidism]. ACTA ACUST UNITED AC 2021; 67:68-83. [PMID: 34533015 DOI: 10.14341/probl12800] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 11/06/2022]
Abstract
Hypoparathyroidism is a rare disorder characterized by the absent or inappropriately decreased serum parathyroid hormone in the parathyroid glands, which is accompanied by impaired calcium-phosphorus metabolism.The main etiology of hypoparathyroidism remains damage or removal of the parathyroid glands during neck surgery. In view of the incidence of thyroid cancer, primary hyperparathyroidism and other pathologies of the neck organs, which radical treatment can lead to the parathyroid gland impairment, an increased number of patients with hypoparathyroidism is expected. Autoimmune hypoparathyroidism is the second most common form of the disease, usually occurring as part of type 1 autoimmune polyglandular syndrome. Autoimmune hypoparathyroidism usually occurs in childhood and is characterized by a severe course of the disease, especially in the case of concomitant malabsorption syndrome.Chronic hypoparathyroidism of any etiology requires lifelong multicomponent therapy, as well as careful monitoring and an individual approach to choose the optimal treatment strategy. In the absence of adequate follow-up, the risks of long-term complications significantly increase, particularly in the renal, cardiovascular systems; in the soft tissues and in the brain, it could lead to visual disturbances; pathology of the musculoskeletal system with a decreased bone remodeling and a potential risk of fractures, as well as to the neurocognitive disorders and an impaired health-related quality of life.Timely diagnosis, rational medical therapy and management strategy may reduce the risks of short-term and long-term complications, frequency of hospitalizations and disability of patients, as well as improve the prognosis.This review covers the main issues of Russian guidelines for the management of chronic hypoparathyroidism, approved in 2021, including laboratory and instrumental evaluation, treatment approaches and follow-up. This guidelines also include the recommendations for special groups of patients: with acute hypocalcemia, hypoparathyroidism during pregnancy.
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Affiliation(s)
| | | | | | | | - I V Kim
- Endocrinology Research Center
| | | | | | - T L Karonova
- National Medical Research Center. V. A. Almazova
| | - I V Kryukova
- Moscow Regional Research Clinical Institute. M.F. Vladimirskogo
| | - A M Mudunov
- National Medical Research Center of Oncology named after V.I. N.N. Blokhin
| | - I V Sleptcov
- Clinic of high medical technologies. N.I. Pirogov St. Petersburg State University
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Kovaleva EV, Eremkina AK, Ajnetdinova AR, Miliutina AP, Mokrysheva NG. [The Russian registry of chronic hypoparathyroidism and clinical decision support system integration]. ACTA ACUST UNITED AC 2021; 67:8-12. [PMID: 34533009 DOI: 10.14341/probl12796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/06/2021] [Accepted: 08/06/2021] [Indexed: 11/06/2022]
Abstract
According to available research, chronic hypoparathyroidism is a relatively rare disease characterized by low serum calcium levels and the absence or deficiency of parathyroid hormone. The chronic course of the disease is associated with the multicomponent medical therapy, careful dynamic monitoring to reduce the risks of various complications in different organs and systems as well as disability and mortality.The Russian registry of patients with chronic postsurgical and nonsurgical hypoparathyroidism has started its work in 2020, based on data of the Endocrinology Research Centre. The main goals of the Registry are the assessment of the actual prevalence, incidence of hypoparathyroidism, the key epidemiological characteristics, the analysis of the clinical features and medical therapy of chronic hypoparathyroidism in Russian Federation.This article covers all objectives of this project, the methodology for maintaining the registry of chronic postsurgical and nonsurgical hypoparathyroidism, the analytical possibilities of its use, including the integration of a decision support system designed to help specialists in real clinical practice follow the algorithms for diagnosis and treatment of the disease, approved by clinical guidelines.The registry of chronic postsurgical and nonsurgical hypoparathyroidism is located on a single platform for the registers of endocrinopathies, regulated by the Endocrinology Research Centre (http://gipopt.clin-reg.ru/).
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Winer KK, Ye S, Ferré EMN, Schmitt MM, Zhang B, Cutler GB, Lionakis MS. Therapy with PTH 1-34 or calcitriol and calcium in diverse etiologies of hypoparathyroidism over 27 years at a single tertiary care center. Bone 2021; 149:115977. [PMID: 33932619 DOI: 10.1016/j.bone.2021.115977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/14/2021] [Accepted: 04/22/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Hypoparathyroidism has heterogeneous genetic and acquired etiologies with a broad spectrum of severity. Herein we describe the clinical outcomes of the largest cohort of hypoparathyroid patients reported to date, who were followed over 27-years. DESIGN Pooled analysis of current and past studies describing the differential responses to PTH 1-34 injections vs conventional therapy among the varied hypoPT etiologies. METHODS 192 participants (ages 2-74 years) with hypoparathyroidism who received either calcitriol and calcium or PTH 1-34 by subcutaneous injection. RESULTS Among the 4 main etiologic categories of hypoparathyroidism (autoimmune polyglandular failure type 1, activating mutation of the calcium receptor, surgical, and idiopathic hypoparathyroidism), we reveal significant differences in PTH 1-34 dose requirements, prevalence of nephrocalcinosis, biomarkers of mineral homeostasis, and pharmacodynamic profiles. Serum 1,25-dihydroxyvitamin D3 increased significantly (P < 0.001) and 25-hydroxyvitamin D levels decreased during PTH 1-34 injections compared to calcitriol therapy (P < 0.01). Post-surgical patients achieved consistently lower urine calcium excretion over long-term PTH 1-34 therapy compared to conventional therapy (p < 0.001), but this was not achieved in the other etiologies. At study entry, patients had a high prevalence of renal insufficiency and nephrocalcinosis which were directly related to the duration of hypoparathyroidism (P < 0.03). Renal function remained stable during participation in our studies for both PTH 1-34 and conventional therapies. CONCLUSIONS We conclude that the effects and dose-response of PTH 1-34 treatment differ according to the etiology of hypoparathyroidism. Postsurgical hypoPT maintained mean serum calcium levels in the mid- to low-normal range while concurrently maintaining normal mean urine calcium during long-term twice-daily PTH 1-34 therapy.
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Affiliation(s)
- Karen K Winer
- Eunice Kennedy Shriver National Institutes of Child Health and Human Development (NICHD), NIH, Bethesda, MD, USA.
| | - Shangyuan Ye
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - Elise M N Ferré
- Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, MD, USA
| | - Monica M Schmitt
- Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, MD, USA
| | - Bo Zhang
- Department of Neurology and ICCTR Biostatistics and Research Design Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gordon B Cutler
- Eunice Kennedy Shriver National Institutes of Child Health and Human Development (NICHD), NIH, Bethesda, MD, USA
| | - Michail S Lionakis
- Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, MD, USA
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Hussain I, Zulfiqar F, Li X, Ahmad S, Aljammal J. Safety and Efficacy of Radiofrequency Ablation of Thyroid Nodules-Expanding Treatment Options in the United States. J Endocr Soc 2021; 5:bvab110. [PMID: 34258495 PMCID: PMC8271212 DOI: 10.1210/jendso/bvab110] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Indexed: 12/15/2022] Open
Abstract
CONTEXT Radiofrequency ablation (RFA) has only recently gained popularity in the United States for treatment of thyroid nodules (TNs), with a limited number of patients having undergone the procedure in this country. OBJECTIVE To evaluate the safety and efficacy of RFA of TNs performed in an outpatient setting in the United States. METHODS This is a retrospective, single-center study of 53 patients who underwent RFA of 58 TNs between November 2018 and January 2021. The reduction in volume of nodule, cosmetic and symptomatic improvement, effect on thyroid function, and complications following RFA were assessed. RESULTS Eleven out of 53 patients were excluded from the analysis. A total of 47 benign TNs (23 nonfunctioning thyroid nodules [NFTNs] and 24 autonomously functioning thyroid nodules [AFTNs]), were assessed after RFA. The median reduction in volume was 70.8% after a median follow-up period of 109 days, with symptomatic and cosmetic improvement (P < 0.0001). Compared with larger nodules, smaller nodules had greater volume reduction (P = 0.0266). RFA improved thyrotropin (TSH) in AFTNs (P value = 0.0015) and did not affect TSH in NFTNs (P value = 0.23). There were no major complications; however, 1 patient had self-limited local bleeding and another had transient voice change that recovered in 6 months. CONCLUSION RFA is a safe and efficacious treatment for symptomatic NFTNs and AFTNs in our population and is especially effective for smaller nodules. RFA should be considered an alternative for TNs in patients who cannot or do not want to undergo surgery.
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Affiliation(s)
- Iram Hussain
- Division of Endocrinology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-8537, USA
| | | | - Xilong Li
- Division of Biostatistics, Department of Population and Data Science, University of Texas Southwestern Medical Center, Dallas, TX 75390-8537, USA
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Hamdy NAT, Decallonne B, Evenepoel P, Gruson D, van Vlokhoven-Verhaegh L. Burden of illness in patients with chronic hypoparathyroidism not adequately controlled with conventional therapy: a Belgium and the Netherlands survey. J Endocrinol Invest 2021; 44:1437-1446. [PMID: 33128157 PMCID: PMC8195792 DOI: 10.1007/s40618-020-01442-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/30/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To determine the burden of illness in patients with not adequately controlled chronic hypoparathyroidism receiving conventional therapy in Belgium and the Netherlands. METHODS Data were generated from a cross-sectional, two-part online survey where endocrinologists from both countries and nephrologists from Belgium were invited by phone to participate. Part 1 included collecting data on general management of patients with hypoparathyroidism. In Part 2, physicians were requested to provide data on one or two current cases of patients with chronic hypoparathyroidism not adequately controlled on conventional therapy. Data collected included aetiology of hypoparathyroidism, clinical manifestations, comorbidities, results of laboratory and other investigations used for diagnosis and screening for complications, therapy received, and physician's perception of impaired quality of life (QoL). RESULTS Thirty-six endocrinologists and 29 nephrologists from Belgium and 28 endocrinologists from the Netherlands participated in the survey. Data included clinical symptoms, biochemical parameters, and QoL for 97 current patients with not adequately controlled chronic hypoparathyroidism on conventional therapy. Median duration of not adequately controlled hypoparathyroidism was 2.2 years, range 0.17-20.0. Most patients had neuromuscular (85%) and/or neurological (67%) symptoms, 71% had abnormal biochemical parameters, 10% were overweight, and physicians perceived that 71% had impaired QoL. Most frequently reported comorbidities included hypertension (25%), renal comorbidity (20%), diabetes mellitus (12%), and dyslipidaemia (11%). CONCLUSION Patients with chronic hypoparathyroidism not adequately controlled on conventional therapy experience a substantial burden of illness, mainly due to persistence of symptoms and presence of multiple comorbidities.
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Affiliation(s)
- N A T Hamdy
- Department of Medicine, Division of Endocrinology, and Centre for Bone Quality, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - B Decallonne
- Department of Endocrinology, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - P Evenepoel
- Department of Microbiology, Immunology and Transplantation, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - D Gruson
- Department of Clinical Biochemistry, Cliniques Universitaires Saint-Luc and Université Catholique de Louvain, Brussels, Belgium
| | - L van Vlokhoven-Verhaegh
- Department of Medical Affairs, Shire Netherlands BV, a Takeda company, Amsterdam, The Netherlands
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Storm P, Underbjerg L, Rejnmark L. Changes in treatment needs for chronic postoperative hypoparathyroidism during initiation of conventional treatment compared to stable phase of treatment. Endocrinol Diabetes Metab 2021; 4:e00269. [PMID: 34277992 PMCID: PMC8279598 DOI: 10.1002/edm2.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION In our clinical experience, need for doses of active vitamin D and calcium supplements changes during the period following a diagnosis of postsurgical hypoparathyroidism (HypoPT), but only sparse data are available. In the present study, we aimed to investigate the magnitude of changes in need for activated vitamin D (alfacalcidol) and calcium supplements during initiation of therapy as well as time to be expected until a stable phase was achieved. Furthermore, we determined the frequency of (unexpected) episodes of hypo- and hypercalcaemia after reaching a steady state for alfacalcidol and calcium. METHODS Retrospective study of twenty-four patients with chronic postsurgical HypoPT (>6 months) diagnosed from 2016 to 2018. Data were extracted from medical records on doses of alfacalcidol and calcium as well as ionized plasma calcium levels (P-Ca2+) from time of diagnosis and until 86 weeks after surgery. RESULTS Patients were treated with alfacalcidol and calcium in order to maintain a stable concentration of P-Ca2+. Our data demonstrated a great variation in treatment needs until 11 weeks after surgery, where the mean doses of alfacalcidol stabilize, while calcium doses stabilized a bit earlier. After the stable phase had emerged, 21 out of 24 patients continued to have one or more episodes of spontaneous hypo- or hypercalcaemia. CONCLUSIONS Patients with chronic HypoPT attain a steady state for alfacalcidol 11 weeks after the diagnosis. Continuous monitoring of P-Ca2+ is of continued importance after reaching steady state due to a high frequency of spontaneous hypo- or hypercalcaemia.
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Affiliation(s)
- Pernille Storm
- Department of Endocrinology and Internal MedicineAarhus University Hospital, Palle Juul‐Jensens BoulevardAarhusDenmark
| | - Line Underbjerg
- Department of Endocrinology and Internal MedicineAarhus University Hospital, Palle Juul‐Jensens BoulevardAarhusDenmark
| | - Lars Rejnmark
- Department of Endocrinology and Internal MedicineAarhus University Hospital, Palle Juul‐Jensens BoulevardAarhusDenmark
- Institute of Clinical MedicineAarhus UniversityAarhusDenmark
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Zavatta G, Tebben PJ, McCollough CH, Yu L, Vrieze T, Clarke BL. Basal Ganglia Calcification Is Associated With Local and Systemic Metabolic Mechanisms in Adult Hypoparathyroidism. J Clin Endocrinol Metab 2021; 106:1900-1917. [PMID: 33788935 DOI: 10.1210/clinem/dgab162] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Hypoparathyroidism is characterized by low serum calcium, increased serum phosphorus, and inappropriately low or decreased serum parathyroid hormone, which may be associated with soft tissue calcification in the basal ganglia of the brain. OBJECTIVE To assess the prevalence and factors involved in the pathophysiology of basal ganglia calcification (BGC) in the brain in chronic hypoparathyroidism and to evaluate proposed pathophysiologic mechanisms. DESIGN Case-control study with retrospective review of medical records over 20 years. SETTING Single academic medical center. PATIENTS 142 patients with chronic hypoparathyroidism and computed tomography (CT) head scans followed between January 1, 2000 and July 9, 2020, and 426 age- and sex-matched controls with CT head scans over the same interval. INTERVENTIONS None. MAIN OUTCOME MEASURES Demographic, biochemical, and CT head imaging findings, with semiquantitative assessment of volumetric BGC. RESULTS The study found that 25.4% of 142 patients followed for a median of 17 years after diagnosis of chronic hypoparathyroidism had BGC, which developed at a younger age than in controls. BGC was 5.1-fold more common in nonsurgical patients and less common in postsurgical patients. Low serum calcium and low calcium/phosphate ratio correlated with BGC. Neither serum phosphorus nor calcium × phosphate product predicted BGC. Lower serum calcium was associated with greater volume of BGC. The extent of BGC varied widely, with nonsurgical patients generally having a greater volume and distribution of calcification. CONCLUSIONS BGC is associated with low serum calcium and low serum calcium/phosphate ratio, which may be related to severity of the disease, its etiology, or duration of treatment.
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Affiliation(s)
- Guido Zavatta
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Peter J Tebben
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | | | - Lifeng Yu
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Thomas Vrieze
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Bart L Clarke
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
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Khan AA, AbuAlrob H, Punthakee Z, Shrayyef M, Werfalli RE, Kassem HA, Braga M, Millar A, Hussain S, Iqbal S, Khan T, Paul T, Van Uum S, Young JEM. Canadian national hypoparathyroidism registry: an overview of hypoparathyroidism in Canada. Endocrine 2021; 72:553-561. [PMID: 33655415 DOI: 10.1007/s12020-021-02629-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/09/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the epidemiology, presentation and management of hypoparathyroidism in Canada. Hypoparathyroidism is associated with significant morbidity and poor quality of life. We present baseline results from the Canadian National Hypoparathyroidism Registry, a prospective observational study evaluating hypoparathyroidism in Canada. METHODS Our study enrolled 130 patients with hypoparathyroidism. Patients were followed every 6 months with clinical and lab assessments. We present baseline data in this manuscript. RESULTS Seventy percent (91/130) of patients had postsurgical hypoparathyroidism, 30% (39/130) of patients had nonsurgical hypoparathyroidism due to autoimmune, genetic or idiopathic causes, and a molecular diagnosis was confirmed in 11 of these 39 patients. Pseudohypoparathyroidism was confirmed in 4/39 patients, DiGeorge syndrome in 2/39 patients, Barakat syndrome with a mutation in the GATA3 gene in 1/39, and activating mutations of the CASR gene in 3/39 patients with nonsurgical hypoparathyroidism. Renal complications with nephrocalcinosis or nephrolithiasis were present in 27% (14/52) of patients with postsurgical disease and 17% (4/24) of patients with nonsurgical hypoparathyroidism. Basal ganglia calcification was noted on imaging in 15% (n = 5/34) of patients with postsurgical hypoparathyroidism and 37% (n = 7/19) of patients with nonsurgical hypoparathyroidism. CONCLUSIONS Hypercalciuria was more commonly seen in those with renal complications of nephrocalcinosis, nephrolithiasis or CKD, and hyperphosphatemia was more commonly seen in those with basal ganglia calcification. Hospitalization occurred in 28% of those with postsurgical hypoparathyroidism and 46% of those with nonsurgical hypoparathyroidism. Hypoparathyroidism is associated with significant morbidity. Effective strategies to reduce the short-and long-term complications of hypoparathyroidism need to be developed and evaluated.
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Affiliation(s)
- Aliya A Khan
- McMaster University, Hamilton, ON, Canada.
- Bone Research and Education Centre, Oakville, ON, Canada.
| | | | | | | | | | | | | | | | | | - Salman Iqbal
- Bone Research and Education Centre, Oakville, ON, Canada
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