Signs and Symptoms of Hypoparathyroidism

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Key points

  • Hypoparathyroidism is associated with a large spectrum of clinical manifestations in the acute and chronic settings, from mild to debilitating.

  • Although the acute symptoms of hypoparathyroidism are primarily due to neuromuscular irritability associated with hypocalcemia, the chronic manifestations may be due to the disease itself or to complications of therapy.

  • The chronic complications of hypoparathyroidism can affect multiple organ systems, including the renal, neurologic, neuropsychiatric,

Acute manifestations of hypoparathyroidism

The maintenance of a normal extracellular ionized calcium concentration is critical for multiple tissues and organ systems, including the brain, heart, and skeletal muscles. Acute or severe hypocalcemia can cause well-recognized manifestations, some life-threatening, and potentially leading to respiratory or cardiac arrest.1, 2 The rate of development and severity of hypocalcemia may affect the presentation. Other factors, such as hypomagnesemia or concomitant alkalosis in which the partition

Chronic manifestations of hypoparathyroidism

The chronic complications of hypoparathyroidism can affect multiple organ systems, including the renal, neurologic, neuropsychiatric, skeletal, and immune systems. These manifestations of hypoparathyroidism may be due to the disease itself or to complications of therapy. Low PTH concentrations, chronic hypocalcemia, relative hypercalcemia, hyperphosphatemia, an elevated calcium × phosphate product, and hypercalciuria have all been postulated to cause the chronic manifestations of

Mortality

There are very few data regarding mortality in patients with hypoparathyroidism compared with controls. In the studies from Underbjerg and colleagues,23, 24, 25 mortality was not increased in surgical (HR 0.98, 95% CI 0.76–1.26) or nonsurgical hypoparathyroidism (HR 1.25, 95% CI 0.90–1.73). Of note, Underbjerg and colleagues23, 24, 25 excluded patients with multiple endocrine neoplasia syndrome, individuals with hypoparathyroidism resulting from surgery for thyroid or parathyroid cancer or

Summary

The acute symptoms of hypoparathyroidism are primarily due to neuromuscular irritability associated with hypocalcemia, and can include tetany, seizures, papilledema, delirium, and cognitive impairment. The chronic manifestations may be due to the disease itself or to complications of therapy. In particular, there is concern for the renal system, with patients at increased risk of nephrocalcinosis, nephrolithiasis, and renal insufficiency. Basal ganglia calcification and decreased quality of

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References (63)

  • T.B. Usdin et al.

    Identification and functional expression of a receptor selectively recognizing parathyroid hormone, the PTH2 receptor

    J Biol Chem

    (1995)
  • N.L. Cho et al.

    Surgeons and patients disagree on the potential consequences from hypoparathyroidism

    Endocr Pract

    (2014)
  • Gel-H. Fuleihan et al.

    Dermatologic manifestations of parathyroid-related disorders

    Clin Dermatol

    (2006)
  • M.S. Cooper et al.

    Diagnosis and management of hypocalcaemia

    BMJ

    (2008)
  • M. Mannstadt et al.

    Clinical manifestations of hypoparathyroidism

  • P. Han et al.

    Hypocalcemia-induced seizure: demystifying the calcium paradox

    ASN Neuro

    (2015)
  • F.L. Urbano

    Signs of hypocalcemia: Chvostek’s and Trousseau’s signs

    Hosp Physician

    (2000)
  • O.A. Fonseca et al.

    Neurological manifestations of hypoparathyroidism

    Arch Intern Med

    (1967)
  • M. Schaaf et al.

    Effect of diphenylhydantoin and phenobarbital on overt and latent tetany

    N Engl J Med

    (1966)
  • T.M. Davis et al.

    Dynamic assessment of the electrocardiographic QT interval during citrate infusion in healthy volunteers

    Br Heart J

    (1995)
  • T. Novick et al.

    Cinacalcet-associated severe hypocalcemia resulting in torsades de pointes and cardiac arrest: a case for caution

    Eur J Clin Pharmacol

    (2016)
  • M. Mrowka et al.

    Hypocalcemic generalised seizures as a manifestation of iatrogenic hypoparathyroidism months to years after thyroid surgery

    Epileptic Disord

    (2004)
  • L.S. Basser et al.

    Epilepsy and electroencephalographic abnormalities in chronic surgical hypoparathyroidism

    Ann Intern Med

    (1969)
  • M. Swash et al.

    Electroencephalographic criteria of hypocalcemia and hypercalcemia

    Arch Neurol

    (1972)
  • C. McLean et al.

    Optic disc involvement in hypocalcaemia with hypoparathyroidism: papilloedema or optic neuropathy?

    Neuroophthalmology

    (1998)
  • P.J. Velasco et al.

    Psychiatric aspects of parathyroid disease

    Psychosomatics

    (1999)
  • A.W. Ang et al.

    Calcium, magnesium, and psychotic symptoms in a girl with idiopathic hypoparathyroidism

    Psychosom Med

    (1995)
  • D.M. Mitchell et al.

    Long-term follow-up of patients with hypoparathyroidism

    J Clin Endocrinol Metab

    (2012)
  • L. Underbjerg et al.

    Postsurgical hypoparathyroidism—risk of fractures, psychiatric diseases, cancer, cataract, and infections

    J Bone Miner Res

    (2014)
  • L. Underbjerg et al.

    Cardiovascular and renal complications to postsurgical hypoparathyroidism: a Danish nationwide controlled historic follow-up study

    J Bone Miner Res

    (2013)
  • L. Underbjerg et al.

    The epidemiology of nonsurgical hypoparathyroidism in Denmark: a nationwide case finding study

    J Bone Miner Res

    (2015)
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    Disclosure Statement: Dr J.P. Bilezikian is a consultant for Amgen, Radius, Shire, and Ultragenyx. Dr N.E. Cusano is a consultant for Shire.

    Funding Source: National Institutes of Health grant DK32333.

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