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Makunts T, Alpatty S, Lee KC, Atayee RS, Abagyan R. Proton-pump inhibitor use is associated with a broad spectrum of neurological adverse events including impaired hearing, vision, and memory. Sci Rep 2019; 9:17280. [PMID: 31754136 PMCID: PMC6872761 DOI: 10.1038/s41598-019-53622-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 10/30/2019] [Indexed: 02/08/2023] Open
Abstract
Proton-pump inhibitors, PPIs, are considered effective therapy for stomach acid suppression due to their irreversible inhibition of the hydrogen/potassium pump in the gastric parietal cells. They are widely prescribed and are considered safe for over-the-counter use. Recent studies have shown an association between PPI use and Alzheimer dementia, while others have disputed that connection. We analyzed over ten million United States Food and Drug Administration Adverse Event Reporting System reports, including over forty thousand reports containing PPIs, and provided evidence of increased propensity for memory impairment among PPI reports when compared to histamine-2 receptor antagonist control group. Furthermore, we found significant associations of PPI use with a wide range of neurological adverse reactions including, migraine, several peripheral neuropathies, and visual and auditory neurosensory abnormalities.
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Affiliation(s)
- Tigran Makunts
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Sama Alpatty
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Kelly C Lee
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Rabia S Atayee
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Ruben Abagyan
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA.
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Tecilazich F, Formenti AM, Frara S, Giubbini R, Giustina A. Treatment of hypoparathyroidism. Best Pract Res Clin Endocrinol Metab 2018; 32:955-964. [PMID: 30551988 DOI: 10.1016/j.beem.2018.12.002] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The goal of the clinical management of hypoparathyroidism is to correct acute and chronic hypocalcemia. Treatment of acute hypoparathyroidism via intravenous infusion of Ca++ salts, is necessary only in symptomatic patients, or in asymptomatic patients in the setting of a rapid decrease in ionized Ca++ levels. The treatment cornerstones of chronic hypoparathyroidism are oral supplementation of calcium and/or active vitamin D, that can be associated with dietary restriction of sodium and phosphates, thiazide diuretics, and phosphate binders. Notably, PTH replacement is emerging as a innovative treatment of chronic hypoparathyroidism. rhPTH (1-84) has been shown to safely reduce calcium and vitamin D dosage, and increase serum calcium levels in hypoparathyroid patients. Therefore, rhPTH (1-84) appears to represent a new option in patients with chronic hypoparathyroidism "resistant" to conventional treatment.
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Affiliation(s)
| | | | - Stefano Frara
- San Raffaele Vita Salute University, IRCCS San Raffaele Hospital, Milan, Italy.
| | | | - Andrea Giustina
- San Raffaele Vita Salute University, IRCCS San Raffaele Hospital, Milan, Italy.
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Perkins KL, Arranz AM, Yamaguchi Y, Hrabetova S. Brain extracellular space, hyaluronan, and the prevention of epileptic seizures. Rev Neurosci 2017; 28:869-892. [PMID: 28779572 PMCID: PMC5705429 DOI: 10.1515/revneuro-2017-0017] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 06/03/2017] [Indexed: 01/08/2023]
Abstract
Mutant mice deficient in hyaluronan (HA) have an epileptic phenotype. HA is one of the major constituents of the brain extracellular matrix. HA has a remarkable hydration capacity, and a lack of HA causes reduced extracellular space (ECS) volume in the brain. Reducing ECS volume can initiate or exacerbate epileptiform activity in many in vitro models of epilepsy. There is both in vitro and in vivo evidence of a positive feedback loop between reduced ECS volume and synchronous neuronal activity. Reduced ECS volume promotes epileptiform activity primarily via enhanced ephaptic interactions and increased extracellular potassium concentration; however, the epileptiform activity in many models, including the brain slices from HA synthase-3 knockout mice, may still require glutamate-mediated synaptic activity. In brain slice epilepsy models, hyperosmotic solution can effectively shrink cells and thus increase ECS volume and block epileptiform activity. However, in vivo, the intravenous administration of hyperosmotic solution shrinks both brain cells and brain ECS volume. Instead, manipulations that increase the synthesis of high-molecular-weight HA or decrease its breakdown may be used in the future to increase brain ECS volume and prevent seizures in patients with epilepsy. The prevention of epileptogenesis is also a future target of HA manipulation. Head trauma, ischemic stroke, and other brain insults that initiate epileptogenesis are known to be associated with an early decrease in high-molecular-weight HA, and preventing that decrease in HA may prevent the epileptogenesis.
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Affiliation(s)
- Katherine L. Perkins
- Department of Physiology and Pharmacology, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA
- The Robert F. Furchgott Center for Neural and Behavioral Science, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Amaia M. Arranz
- VIB Center for Brain and Disease Research, 3000 Leuven, Belgium; and KU Leuven Department for Neurosciences, Leuven Institute for Neurodegenerative Disorders (LIND) and Universitaire Ziekenhuizen Leuven, University of Leuven, 3000 Leuven, Belgium
| | - Yu Yamaguchi
- Human Genetics Program, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, California 92037, USA
| | - Sabina Hrabetova
- The Robert F. Furchgott Center for Neural and Behavioral Science, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA
- Department of Cell Biology, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA
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Sáez ME, González-Pérez A, Gaist D, Johansson S, Nagy P, García Rodríguez LA. Risk of seizure associated with use of acid-suppressive drugs: An observational cohort study. Epilepsy Behav 2016; 62:72-80. [PMID: 27450309 DOI: 10.1016/j.yebeh.2016.06.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 06/24/2016] [Accepted: 06/27/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Previous, large, prescription-event monitoring studies in patients receiving PPI therapy recorded instances of convulsion or seizure. The objective of this study was to quantify the relative risk of seizure associated with the use of proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) in a general population, overall and stratified by epilepsy status, and to determine the effects of demographics and comorbidities. METHODS In this observational study (NCT01744301), patients aged 20-84years in the study period from 1 January 2005 to 31 December 2011 were identified from The Health Improvement Network. In a nested case-control analysis, 8605 patients with seizure were matched to 40000 controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression. RESULTS After adjustment, there were no associations between current PPI use and seizure risk in the overall population (OR: 1.05; 95% CI: 0.87-1.27), the subcohort with epilepsy (OR: 0.87; 95% CI: 0.49-1.53), and the subcohort without epilepsy (OR: 1.05; 95% CI: 0.87-1.28). There were no associations between current H2RA use and seizure risk in the overall population (OR: 1.16; 95% CI: 0.62-2.18) and the subcohort without epilepsy (OR: 1.02; 95% CI: 0.51-2.01). Seizures were less frequent in women than in men. Dementia/psychosis, anxiety, depression, and use of anxiolytics, antidepressants, and paracetamol were associated with an increased seizure risk. CONCLUSIONS Our study revealed that the use of PPIs and the use of H2RAs were not associated with an increased risk of seizures in the overall population or in the cohorts stratified by epilepsy status.
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Affiliation(s)
- María E Sáez
- Spanish Centre for Pharmacoepidemiologic Research (CEIFE), Madrid, Spain; Andalusian Bioinformatics Research Centre (CAEBi), Seville, Spain
| | - Antonio González-Pérez
- Spanish Centre for Pharmacoepidemiologic Research (CEIFE), Madrid, Spain; Andalusian Bioinformatics Research Centre (CAEBi), Seville, Spain
| | - David Gaist
- Department of Neurology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Bilezikian JP, Brandi ML, Cusano NE, Mannstadt M, Rejnmark L, Rizzoli R, Rubin MR, Winer KK, Liberman UA, Potts JT. Management of Hypoparathyroidism: Present and Future. J Clin Endocrinol Metab 2016; 101:2313-24. [PMID: 26938200 PMCID: PMC5393596 DOI: 10.1210/jc.2015-3910] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
CONTEXT Conventional management of hypoparathyroidism has focused upon maintaining the serum calcium with oral calcium and active vitamin D, often requiring high doses and giving rise to concerns about long-term consequences including renal and brain calcifications. Replacement therapy with PTH has recently become available. This paper summarizes the results of the findings and recommendations of the Working Group on Management of Hypoparathyroidism. EVIDENCE ACQUISITION Contributing authors reviewed the literature regarding physiology, pathophysiology, and nutritional aspects of hypoparathyroidism, management of acute hypocalcemia, clinical aspects of chronic management, and replacement therapy of hypoparathyroidism with PTH peptides. PubMed and other literature search engines were utilized. EVIDENCE SYNTHESIS Under normal circumstances, interactions between PTH and active vitamin D along with the dynamics of calcium and phosphorus absorption, renal tubular handing of those ions, and skeletal responsiveness help to maintain calcium homeostasis and skeletal health. In the absence of PTH, the gastrointestinal tract, kidneys, and skeleton are all affected, leading to hypocalcemia, hyperphosphatemia, reduced bone remodeling, and an inability to conserve filtered calcium. Acute hypocalcemia can be a medical emergency presenting with neuromuscular irritability. The recent availability of recombinant human PTH (1-84) has given hope that management of hypoparathyroidism with the missing hormone in this disorder will provide better control and reduced needs for calcium and vitamin D. CONCLUSIONS Hypoparathyroidism is associated with abnormal calcium and skeletal homeostasis. Control with calcium and active vitamin D can be a challenge. The availability of PTH (1-84) replacement therapy may usher new opportunities for better control with reduced supplementation requirements.
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Affiliation(s)
- John P Bilezikian
- Columbia University College of Physicians & Surgeons (J.P.B., N.E.C., M.R.R.), New York, New York 10032; Department of Surgery and Translational Medicine (M.L.B.), University of Florence, 50121 Florence, Italy; Massachusetts General Hospital (M.M., J.T.P.), Boston, Massachusetts 02114; Aarhus University Hospital (L.R.), 8000 Aarhus, Denmark; Geneva University Hospitals and Faculty of Medicine (R.R.), 1205 Geneva, Switzerland; Eunice Kennedy Shriver National Institute of Child Health and Human Development (K.K.W.), National Institutes of Health, Bethesda, Maryland 20892; and Sackler School of Medicine (U.A.L.), Tel Aviv University, Tel Aviv 6997801, Israel
| | - Maria Luisa Brandi
- Columbia University College of Physicians & Surgeons (J.P.B., N.E.C., M.R.R.), New York, New York 10032; Department of Surgery and Translational Medicine (M.L.B.), University of Florence, 50121 Florence, Italy; Massachusetts General Hospital (M.M., J.T.P.), Boston, Massachusetts 02114; Aarhus University Hospital (L.R.), 8000 Aarhus, Denmark; Geneva University Hospitals and Faculty of Medicine (R.R.), 1205 Geneva, Switzerland; Eunice Kennedy Shriver National Institute of Child Health and Human Development (K.K.W.), National Institutes of Health, Bethesda, Maryland 20892; and Sackler School of Medicine (U.A.L.), Tel Aviv University, Tel Aviv 6997801, Israel
| | - Natalie E Cusano
- Columbia University College of Physicians & Surgeons (J.P.B., N.E.C., M.R.R.), New York, New York 10032; Department of Surgery and Translational Medicine (M.L.B.), University of Florence, 50121 Florence, Italy; Massachusetts General Hospital (M.M., J.T.P.), Boston, Massachusetts 02114; Aarhus University Hospital (L.R.), 8000 Aarhus, Denmark; Geneva University Hospitals and Faculty of Medicine (R.R.), 1205 Geneva, Switzerland; Eunice Kennedy Shriver National Institute of Child Health and Human Development (K.K.W.), National Institutes of Health, Bethesda, Maryland 20892; and Sackler School of Medicine (U.A.L.), Tel Aviv University, Tel Aviv 6997801, Israel
| | - Michael Mannstadt
- Columbia University College of Physicians & Surgeons (J.P.B., N.E.C., M.R.R.), New York, New York 10032; Department of Surgery and Translational Medicine (M.L.B.), University of Florence, 50121 Florence, Italy; Massachusetts General Hospital (M.M., J.T.P.), Boston, Massachusetts 02114; Aarhus University Hospital (L.R.), 8000 Aarhus, Denmark; Geneva University Hospitals and Faculty of Medicine (R.R.), 1205 Geneva, Switzerland; Eunice Kennedy Shriver National Institute of Child Health and Human Development (K.K.W.), National Institutes of Health, Bethesda, Maryland 20892; and Sackler School of Medicine (U.A.L.), Tel Aviv University, Tel Aviv 6997801, Israel
| | - Lars Rejnmark
- Columbia University College of Physicians & Surgeons (J.P.B., N.E.C., M.R.R.), New York, New York 10032; Department of Surgery and Translational Medicine (M.L.B.), University of Florence, 50121 Florence, Italy; Massachusetts General Hospital (M.M., J.T.P.), Boston, Massachusetts 02114; Aarhus University Hospital (L.R.), 8000 Aarhus, Denmark; Geneva University Hospitals and Faculty of Medicine (R.R.), 1205 Geneva, Switzerland; Eunice Kennedy Shriver National Institute of Child Health and Human Development (K.K.W.), National Institutes of Health, Bethesda, Maryland 20892; and Sackler School of Medicine (U.A.L.), Tel Aviv University, Tel Aviv 6997801, Israel
| | - René Rizzoli
- Columbia University College of Physicians & Surgeons (J.P.B., N.E.C., M.R.R.), New York, New York 10032; Department of Surgery and Translational Medicine (M.L.B.), University of Florence, 50121 Florence, Italy; Massachusetts General Hospital (M.M., J.T.P.), Boston, Massachusetts 02114; Aarhus University Hospital (L.R.), 8000 Aarhus, Denmark; Geneva University Hospitals and Faculty of Medicine (R.R.), 1205 Geneva, Switzerland; Eunice Kennedy Shriver National Institute of Child Health and Human Development (K.K.W.), National Institutes of Health, Bethesda, Maryland 20892; and Sackler School of Medicine (U.A.L.), Tel Aviv University, Tel Aviv 6997801, Israel
| | - Mishaela R Rubin
- Columbia University College of Physicians & Surgeons (J.P.B., N.E.C., M.R.R.), New York, New York 10032; Department of Surgery and Translational Medicine (M.L.B.), University of Florence, 50121 Florence, Italy; Massachusetts General Hospital (M.M., J.T.P.), Boston, Massachusetts 02114; Aarhus University Hospital (L.R.), 8000 Aarhus, Denmark; Geneva University Hospitals and Faculty of Medicine (R.R.), 1205 Geneva, Switzerland; Eunice Kennedy Shriver National Institute of Child Health and Human Development (K.K.W.), National Institutes of Health, Bethesda, Maryland 20892; and Sackler School of Medicine (U.A.L.), Tel Aviv University, Tel Aviv 6997801, Israel
| | - Karen K Winer
- Columbia University College of Physicians & Surgeons (J.P.B., N.E.C., M.R.R.), New York, New York 10032; Department of Surgery and Translational Medicine (M.L.B.), University of Florence, 50121 Florence, Italy; Massachusetts General Hospital (M.M., J.T.P.), Boston, Massachusetts 02114; Aarhus University Hospital (L.R.), 8000 Aarhus, Denmark; Geneva University Hospitals and Faculty of Medicine (R.R.), 1205 Geneva, Switzerland; Eunice Kennedy Shriver National Institute of Child Health and Human Development (K.K.W.), National Institutes of Health, Bethesda, Maryland 20892; and Sackler School of Medicine (U.A.L.), Tel Aviv University, Tel Aviv 6997801, Israel
| | - Uri A Liberman
- Columbia University College of Physicians & Surgeons (J.P.B., N.E.C., M.R.R.), New York, New York 10032; Department of Surgery and Translational Medicine (M.L.B.), University of Florence, 50121 Florence, Italy; Massachusetts General Hospital (M.M., J.T.P.), Boston, Massachusetts 02114; Aarhus University Hospital (L.R.), 8000 Aarhus, Denmark; Geneva University Hospitals and Faculty of Medicine (R.R.), 1205 Geneva, Switzerland; Eunice Kennedy Shriver National Institute of Child Health and Human Development (K.K.W.), National Institutes of Health, Bethesda, Maryland 20892; and Sackler School of Medicine (U.A.L.), Tel Aviv University, Tel Aviv 6997801, Israel
| | - John T Potts
- Columbia University College of Physicians & Surgeons (J.P.B., N.E.C., M.R.R.), New York, New York 10032; Department of Surgery and Translational Medicine (M.L.B.), University of Florence, 50121 Florence, Italy; Massachusetts General Hospital (M.M., J.T.P.), Boston, Massachusetts 02114; Aarhus University Hospital (L.R.), 8000 Aarhus, Denmark; Geneva University Hospitals and Faculty of Medicine (R.R.), 1205 Geneva, Switzerland; Eunice Kennedy Shriver National Institute of Child Health and Human Development (K.K.W.), National Institutes of Health, Bethesda, Maryland 20892; and Sackler School of Medicine (U.A.L.), Tel Aviv University, Tel Aviv 6997801, Israel
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Brandi ML, Bilezikian JP, Shoback D, Bouillon R, Clarke BL, Thakker RV, Khan AA, Potts JT. Management of Hypoparathyroidism: Summary Statement and Guidelines. J Clin Endocrinol Metab 2016; 101:2273-83. [PMID: 26943719 DOI: 10.1210/jc.2015-3907] [Citation(s) in RCA: 218] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Hypoparathyroidism is a rare disorder characterized by hypocalcemia and absent or deficient PTH. This report presents a summary of current information about epidemiology, presentation, diagnosis, clinical features, and management and proposes guidelines to help clinicians diagnose, evaluate, and manage this disorder. PARTICIPANTS Participants in the First International Conference on the Management of Hypoparathyroidism represented a worldwide constituency with acknowledged interest and expertise in key basic, translational, and clinical aspects of hypoparathyroidism. Three Workshop Panels were constituted to address questions for presentation and discussion at the Conference held in Florence, Italy, May 7-9, 2015. At that time, a series of presentations were made, followed by in-depth discussions in an open forum. Each Workshop Panel also met in closed sessions to formulate the three evidence-based reports that accompany this summary statement. An Expert Panel then considered this information, developed summaries, guidelines, and a research agenda that constitutes this summary statement. EVIDENCE Preceding the conference, each Workshop Panel conducted an extensive literature search as noted in the individual manuscripts accompanying this report. All presentations were based upon the best peer-reviewed information taking into account the historical and current literature. CONSENSUS PROCESS This report represents the Expert Panel's synthesis of the conference material placed in a context designed to be relevant to clinicians and those engaged in cutting-edge studies of hypoparathyroidism. CONCLUSIONS This document not only provides a summary of our current knowledge but also places recent advances in its management into a context that should enhance future advances in our understanding of hypoparathyroidism.
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Affiliation(s)
- Maria Luisa Brandi
- Department of Surgery and Translational Medicine (M.L.B.), University of Florence, 50121 Florence, Italy; Columbia University College of Physicians & Surgeons (J.P.B.), New York, New York 10032; Endocrine Research Unit (D.S.), San Francisco Department of Veterans Affairs Medical Center, University of California, San Francisco, California 94121; Clinic and Laboratory of Experimental Endocrinology (R.B.), Gasthuisberg, KU Leuven, 3000 Leuven, Belgium; Mayo Clinic (B.C.), Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Rochester, Minnesota 55905; Academic Endocrine Unit (R.V.T.), Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford OX3 7LJ, United Kingdom; McMaster University Calcium Disorders Clinic (A.A.K.), Hamilton, Canada L8S4L8; and Massachusetts General Hospital (J.T.P.), Boston, Massachusetts 02114
| | - John P Bilezikian
- Department of Surgery and Translational Medicine (M.L.B.), University of Florence, 50121 Florence, Italy; Columbia University College of Physicians & Surgeons (J.P.B.), New York, New York 10032; Endocrine Research Unit (D.S.), San Francisco Department of Veterans Affairs Medical Center, University of California, San Francisco, California 94121; Clinic and Laboratory of Experimental Endocrinology (R.B.), Gasthuisberg, KU Leuven, 3000 Leuven, Belgium; Mayo Clinic (B.C.), Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Rochester, Minnesota 55905; Academic Endocrine Unit (R.V.T.), Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford OX3 7LJ, United Kingdom; McMaster University Calcium Disorders Clinic (A.A.K.), Hamilton, Canada L8S4L8; and Massachusetts General Hospital (J.T.P.), Boston, Massachusetts 02114
| | - Dolores Shoback
- Department of Surgery and Translational Medicine (M.L.B.), University of Florence, 50121 Florence, Italy; Columbia University College of Physicians & Surgeons (J.P.B.), New York, New York 10032; Endocrine Research Unit (D.S.), San Francisco Department of Veterans Affairs Medical Center, University of California, San Francisco, California 94121; Clinic and Laboratory of Experimental Endocrinology (R.B.), Gasthuisberg, KU Leuven, 3000 Leuven, Belgium; Mayo Clinic (B.C.), Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Rochester, Minnesota 55905; Academic Endocrine Unit (R.V.T.), Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford OX3 7LJ, United Kingdom; McMaster University Calcium Disorders Clinic (A.A.K.), Hamilton, Canada L8S4L8; and Massachusetts General Hospital (J.T.P.), Boston, Massachusetts 02114
| | - Roger Bouillon
- Department of Surgery and Translational Medicine (M.L.B.), University of Florence, 50121 Florence, Italy; Columbia University College of Physicians & Surgeons (J.P.B.), New York, New York 10032; Endocrine Research Unit (D.S.), San Francisco Department of Veterans Affairs Medical Center, University of California, San Francisco, California 94121; Clinic and Laboratory of Experimental Endocrinology (R.B.), Gasthuisberg, KU Leuven, 3000 Leuven, Belgium; Mayo Clinic (B.C.), Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Rochester, Minnesota 55905; Academic Endocrine Unit (R.V.T.), Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford OX3 7LJ, United Kingdom; McMaster University Calcium Disorders Clinic (A.A.K.), Hamilton, Canada L8S4L8; and Massachusetts General Hospital (J.T.P.), Boston, Massachusetts 02114
| | - Bart L Clarke
- Department of Surgery and Translational Medicine (M.L.B.), University of Florence, 50121 Florence, Italy; Columbia University College of Physicians & Surgeons (J.P.B.), New York, New York 10032; Endocrine Research Unit (D.S.), San Francisco Department of Veterans Affairs Medical Center, University of California, San Francisco, California 94121; Clinic and Laboratory of Experimental Endocrinology (R.B.), Gasthuisberg, KU Leuven, 3000 Leuven, Belgium; Mayo Clinic (B.C.), Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Rochester, Minnesota 55905; Academic Endocrine Unit (R.V.T.), Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford OX3 7LJ, United Kingdom; McMaster University Calcium Disorders Clinic (A.A.K.), Hamilton, Canada L8S4L8; and Massachusetts General Hospital (J.T.P.), Boston, Massachusetts 02114
| | - Rajesh V Thakker
- Department of Surgery and Translational Medicine (M.L.B.), University of Florence, 50121 Florence, Italy; Columbia University College of Physicians & Surgeons (J.P.B.), New York, New York 10032; Endocrine Research Unit (D.S.), San Francisco Department of Veterans Affairs Medical Center, University of California, San Francisco, California 94121; Clinic and Laboratory of Experimental Endocrinology (R.B.), Gasthuisberg, KU Leuven, 3000 Leuven, Belgium; Mayo Clinic (B.C.), Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Rochester, Minnesota 55905; Academic Endocrine Unit (R.V.T.), Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford OX3 7LJ, United Kingdom; McMaster University Calcium Disorders Clinic (A.A.K.), Hamilton, Canada L8S4L8; and Massachusetts General Hospital (J.T.P.), Boston, Massachusetts 02114
| | - Aliya A Khan
- Department of Surgery and Translational Medicine (M.L.B.), University of Florence, 50121 Florence, Italy; Columbia University College of Physicians & Surgeons (J.P.B.), New York, New York 10032; Endocrine Research Unit (D.S.), San Francisco Department of Veterans Affairs Medical Center, University of California, San Francisco, California 94121; Clinic and Laboratory of Experimental Endocrinology (R.B.), Gasthuisberg, KU Leuven, 3000 Leuven, Belgium; Mayo Clinic (B.C.), Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Rochester, Minnesota 55905; Academic Endocrine Unit (R.V.T.), Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford OX3 7LJ, United Kingdom; McMaster University Calcium Disorders Clinic (A.A.K.), Hamilton, Canada L8S4L8; and Massachusetts General Hospital (J.T.P.), Boston, Massachusetts 02114
| | - John T Potts
- Department of Surgery and Translational Medicine (M.L.B.), University of Florence, 50121 Florence, Italy; Columbia University College of Physicians & Surgeons (J.P.B.), New York, New York 10032; Endocrine Research Unit (D.S.), San Francisco Department of Veterans Affairs Medical Center, University of California, San Francisco, California 94121; Clinic and Laboratory of Experimental Endocrinology (R.B.), Gasthuisberg, KU Leuven, 3000 Leuven, Belgium; Mayo Clinic (B.C.), Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Rochester, Minnesota 55905; Academic Endocrine Unit (R.V.T.), Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford OX3 7LJ, United Kingdom; McMaster University Calcium Disorders Clinic (A.A.K.), Hamilton, Canada L8S4L8; and Massachusetts General Hospital (J.T.P.), Boston, Massachusetts 02114
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Abstract
Calcium is essential for both neurotransmitter release and muscle contraction. Given these important physiological processes, it seems reasonable to assume that hypocalcemia may lead to reduced neuromuscular excitability. Counterintuitively, however, clinical observation has frequently documented hypocalcemia’s role in induction of seizures and general excitability processes such as tetany, Chvostek’s sign, and bronchospasm. The mechanism of this calcium paradox remains elusive, and very few pathophysiological studies have addressed this conundrum. Nevertheless, several studies primarily addressing other biophysical issues have provided some clues. In this review, we analyze the data of these studies and propose an integrative model to explain this hypocalcemic paradox.
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Affiliation(s)
- Pengcheng Han
- Barrow Neurological Institute, Dignity Health St Joseph's Hospital and Medical Center and Medical Center, Phoenix, AZ, USA
| | - Bradley J Trinidad
- Creighton University School of Medicine-Phoenix Campus, Phoenix, AZ, USA
| | - Jiong Shi
- Barrow Neurological Institute, Dignity Health St Joseph's Hospital and Medical Center and Medical Center, Phoenix, AZ, USA
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Bilezikian JP, Khan A, Potts JT, Brandi ML, Clarke BL, Shoback D, Jüppner H, D'Amour P, Fox J, Rejnmark L, Mosekilde L, Rubin MR, Dempster D, Gafni R, Collins MT, Sliney J, Sanders J. Hypoparathyroidism in the adult: epidemiology, diagnosis, pathophysiology, target-organ involvement, treatment, and challenges for future research. J Bone Miner Res 2011; 26:2317-37. [PMID: 21812031 PMCID: PMC3405491 DOI: 10.1002/jbmr.483] [Citation(s) in RCA: 319] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Recent advances in understanding the epidemiology, genetics, diagnosis, clinical presentations, skeletal involvement, and therapeutic approaches to hypoparathyroidism led to the First International Workshop on Hypoparathyroidism that was held in 2009. At this conference, a group of experts convened to discuss these issues with a view towards a future research agenda for this disease. This review, which focuses primarily on hypoparathyroidism in the adult, provides a comprehensive summary of the latest information on this disease.
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Affiliation(s)
- John P Bilezikian
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
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