Hospitalizations, emergency room visits and causes of death in 198 patients with permanent hypoparathyroidism: a retrospective Austrian study (2005-2022)

OBJECTIVE

Chronic hypoparathyroidism (HP) is associated with acute and chronic complications, especially those related to hypocalcemia. We aimed to analyze details on hospital admissions and the reported deaths in affected patients.

DESIGN AND METHODS

In a retrospective analysis, we reviewed the medical history of 198 patients diagnosed with chronic HP over a continuous period of up to 17 years at the Medical University Graz.

RESULTS

The mean age in our mostly female cohort (70.2%) was 62.6 ± 18.7 years. The etiology was predominantly postsurgical (84.8%). About 87.4% of patients received standard medication (oral calcium/vitamin D), 15 patients (7.6%) used rhPTH1-84/Natpar® and 10 patients (4.5%) had no/unknown medication. Two hundred and nineteen emergency room (ER) visits and 627 hospitalizations were documented among 149 patients, and 49 patients (24.7%) did not record any hospital admissions. According to symptoms and decreased serum calcium levels, 12% of ER (n = 26) visits and 7% of hospitalizations (n = 44) were likely attributable to HP. A subgroup of 13 patients (6.5%) received kidney transplants prior to the HP diagnosis. In eight of these patients, parathyroidectomy for tertiary renal hyperparathyroidism was the cause of permanent HP. The mortality was 7.8% (n = 12), and the causes of death appeared to be unrelated to HP. Although the awareness for HP was low, calcium levels were documented in 71% (n = 447) of hospitalizations.

CONCLUSIONS

Acute symptoms directly related to HP did not represent the primary cause of ER visits. However, comorbidities (e.g. renal/cardiovascular diseases) associated with HP played a key role in hospitalizations and deaths.

SIGNIFICANCE STATEMENT

Hypoparathyroidism (HP) is the most common complication after anterior neck surgery. Yet, it remains underdiagnosed as well as undertreated, and the burden of disease and long-term complications are usually underestimated. There are few detailed data on emergency room (ER) visits hospitalizations and death in patients with chronic HP, although acute symptoms due to hypo-/hypercalcemia are easily detectable. We show that HP is not the primary cause for presentation but that hypocalcemia is a typical laboratory finding (when ordered) and thus may contribute to subjective symptoms. Patients often present with renal/cardiovascular/oncologic illness for which HP is known to be a contributing factor. A small but very special group (n = 13, 6.5%) are patients after kidney transplantations who showed a high ER hospitalization rate. Surprisingly, HP was never the cause for their frequent hospitalizations but rather the result of chronic kidney disease. The most frequent cause for HP in these patients was parathyroidectomy due to tertiary hyperparathyroidism. The causes of death in 12 patients appeared to be unrelated to HP, but we found a high prevalence of chronic organ damages/comorbidities related to it in this group. Less than 25% documented HP correctly in the discharge letters, which indicates a high potential for improvement.

General Scheme for Oxidative Quenching of a Copper Bis-Phenanthroline Photosensitizer for Light-Driven Hydrogen Production

A new, general reaction scheme for photocatalytic hydrogen production is presented based on oxidative quenching of a homoleptic copper(I) bis-1,10-phenanthroline photosensitizer (PS) by 1-methyl-4-phenyl-pyridinium (MPP(+) ) as the electron relay and subsequent regeneration of the so formed copper(II) complex by a sacrificial electron donor. Electron transfer from the relay to various cobalt based water reduction catalysts and subsequent H2 production was shown to close the catalytic cycle. Transient absorption experiments unambiguously confirmed the proposed pathway, both the oxidative quenching and subsequent regeneration of oxidized PS. Photocatalytic test runs further confirmed the role of MPP(+) and up to 10 turnovers were achieved in the relay. The performance limiting factor of the system was shown to be the decomplexation of the copper PS. Quantum yields of the system were 0.03 for H2 production, but 0.6 for MPP(.) formation, clearly indicating that unproductive pathways still prevail.

Hyperandrogenism, postprandial hyperinsulinism and the risk of PCOS in a cross sectional study of women with epilepsy treated with valproate

Among a sample of 43 women with epilepsy treated for at least 2 years with valproate (n=22) or other antiepileptic drugs (AEDs) (n=21), polycystic ovary syndrome (PCOS) was diagnosed in three women, two of them were treated with valproate. Although the rate of PCOS and of menstrual disturbances, weight body mass index (BMI) and waist to hip ratio as well as fasting blood glucose levels, fasting insulin, proinsulin and C-peptide values was similar in this small sample of women treated with valproate and other AEDs, valproate exposure was associated with higher androgen levels, higher postprandial (pp) insulin and proinsulin levels, as well as lower cholesterol and low density lipoprotein (LDL) cholesterol levels. The pronounced increase in pp insulin levels during VPA treatment may indicate an effect of the fatty acid derivate VPA on pancreatic islet cells.

Corticosteroids versus antibiotics

The results of the <i>in vitro</i> and <i>in vivo</i> studies presented here demonstrate that gentamicin and β-methasone-17,21-diproprionate may safely be used together in combined preparations for topical therapy. In the presence of the glucocorticoid, the antibacterial activity of the antibiotic remains unimpaired; such is not the case with all the antibiotics investigated sofar on possible interactions with glucocorticoids. The measurement of topical glucocorticoid potency poses many problems. Among the various methods available, the vasoconstriction assay proved to be the most reliable and valuable device, as there exists an approximate correlation between the potency of glucocorticoids to provoke vasoconstriction and their relative clinical efficacy on skin lesions. In the vasoconstriction assay, the presence of gentamicin in a twentyfold concentration did not change the activity of β-methasone diproprionate. In this study, interactions between gentamicin and β-methasone diproprionate could be ruled out, from the angle of the antibiotic as well as from the angle of the glucocorticoid.

Activation of phosphonomycin, a new antibacterial antibiotic

The antibacterial activity of phosphonomycin, a new antibiotic, was studied by measuring the oxygen consumption of proliferating <i>Staph. aureus </i>CN 491 by the Warburg technique. Previously reported results on the activation of phosphonomycin in the presence of blood could be confirmed. It was shown that addition of human or animal serum to the respiration medium increased the antibacterial effect of phosphonomycin. Similar activation could, however, be obtained by introducing pure human γ-globulin. It was concluded that y-globulin may be the only important factor in blood capable of activating phosphonomycin.