REVIEW ARTICLE
Hypoparathyroidism: is it that easy to treat?
Evangelia Triantafyllou
1
&
Maria P. Yavropoulou
1
&
Athanasios D. Anastasilakis
2
&
Polyzois Makras
3
Received: 23 February 2018 /Accepted: 4 May 2018
#
Hellenic Endocrine Society 2018
Abstract
Hypoparathyroidism is a relatively rare endocrine disease characterised by either null or inappropriately low secretion of
parathyroid hormone (PTH) for serum calcium levels. The other main laboratory findings include hypocalcaemia, inappropri-
ately normal or high urine calcium excretion and hyperphosphataemia with low urine phosphate excretion. The management of
hypoparathyroidism should be tailored to each individual case, which makes it a demanding undertaking in everyday clinical
practice. In this review, we sought to focus on the diagnostic approach of hypoparathyroidism and the therapeutic challenges of
the disease from a clinical perspective. Conventional treatment with vitamin D analogues and calcium salts is no longer the only
available treatment, since replacement treatment with PTH(1-84) has recently been approved for the disease. However, the
optimal treatment schedule is yet to be defined.
Keywords Hypoparathyroidism
.
Calcium
.
PTH1-34
.
PTH1-84
Introduction
Calcium homeostasis is mainly regulated by parathyroid hor-
mone (PTH), while calcitriol, the active form of vitamin D,
and to a considerably lesser extent calcitonin also contribute.
The most common cause of hypocalcaemia is impaired pro-
duction of PTH, regardless of the cause, which fails to main-
tain normocalcaemia and normophosphataemia [1].
Hypoparathyroidism is a relatively rare endocrine disease,
characterised by inappropriately low to null secretion of PTH,
resulting in hypocalcaemia, with inappropriately normal or
even high urine calcium excretion, and hyperphosphataemia,
with low urine phosphate excretion [2]. In this review, we brief-
ly describe the diagnostic approach of hypoparathyroidism and
focus on the therapeutic challenges of the disease from a clinical
perspective. Given the recent advances in the replacement treat-
ment of the disease, conventional treatment with vitamin D
analogues and calcium salts is no longer the only available
approach, albeit the optimal treatment schedule is yet to be
defined.
Epidemiology
Hypoparathyroidism occurs with an incidence of 24–37/
100,000 persons per year [3]. It most commonly affects
middle-aged women, 75% of cases being women, 75%
of whom are 45 years or older. The most common cause
of hypoparathyroidism (75%) is postsurgical procedures
secondary to thyroid, parathyroid, head or neck cancer
surgery [2]. Postsurgical hypoparathyroidism occurs as a
complication in 7–36% of these surgeries, of which 38%
are due to total thyroidectomy, 21% parathyroidectomy,
9% partial thyroidectomy, and 5% due to other neck
surgeries [4].
Other causes of hypoparathyroidism include rare inherited
diseases, such as DiGeorge syndrome type I, Bartter syn-
drome type V, Kenny-Caffey syndrome, hereditary deafness
and renal dysplasia syndrome (HDR), or mutations in the PTH
gene that impair synthesis or bioactivity of PTH [5, 6]. Rare,
non-hereditary causes of hypoparathyroidism include
parathyroid gland damage due to irradiation, infiltrative
This article is a product of the 5th ENDO COMBO, during which a
lecture under the same title was presented as part of the course by the
senior author.
* Polyzois Makras
pmakras@gmail.com
1
Division of Endocrinology and Metabolism, 1st Department of
Internal Medicine, AHEPA University Hospital, Aristotle University
of Thessaloniki, Thessaloniki, Greece
2
Department of Endocrinology, 424 General Military Hospital,
Thessaloniki, Greece
3
Department of Endocrinology and Diabetes, 251 Hellenic Air Force
& VA General Hospital, 3 Kanellopoulou St, 11525 Athens, Greece
Hormones
https://doi.org/10.1007/s42000-018-0032-6
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