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Hypoparathyroidism is associated with a large spectrum of clinical manifestations in the acute and chronic settings, from mild to debilitating.
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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.
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The chronic complications of hypoparathyroidism can affect multiple organ systems, including the renal, neurologic, neuropsychiatric,
Endocrinology and Metabolism Clinics of North America
Signs and Symptoms of Hypoparathyroidism
Section snippets
Key points
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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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.