TY - JOUR
T1 - Hypoparathyroidism
AU - Mannstadt, Michael
AU - Bilezikian, John P.
AU - Thakker, Rajesh V.
AU - Hannan, Fadil M.
AU - Clarke, Bart L.
AU - Reijnmark, Lars
AU - Mitchell, Deborah M.
AU - Vokes, Tamara J.
AU - Winer, Karen K.
AU - Shoback, Dolores M.
N1 - Publisher Copyright:
© 2017 Macmillan Publishers Limited, part of Springer Nature. All rights reserved.
PY - 2017/8/31
Y1 - 2017/8/31
N2 - Hypoparathyroidism is a disease characterized by inadequately low circulating concentrations of parathyroid hormone (PTH) resulting in low calcium levels and increased phosphate levels in the blood. Symptoms of the disease result from increased neuromuscular irritability caused by hypocalcaemia and include tingling, muscle cramps and seizures. The most common cause of the disease is inadvertent removal of, or injury to, the parathyroid glands during neck surgery, followed by genetic, idiopathic and autoimmune aetiologies. Conventional treatment includes activated Vitamin D and/or calcium supplements, but this treatment does not fully replace the functions of PTH and can lead to short-Term problems (such as hypocalcaemia, hypercalcaemia and increased urinary calcium excretion) and long-Term complications (which include nephrocalcinosis, kidney stones and brain calcifications). PTH replacement has emerged as a new treatment option. Clinical trials using human PTH(1-34) and PTH(1-84) showed that this treatment was safe and effective in studies lasting up to 6 years. Recombinant human PTH(1-84) has been approved in the United States and Europe for the management of hypoparathyroidism; however, its effect on long-Term complications is still being evaluated. Clinical practice guidelines, which describe the consensus of experts in the field, have been published and recognize the need for more research to optimize care. In this Primer, we summarize current knowledge of the prevalence, pathophysiology, clinical presentation and management of hypoparathyroidism.
AB - Hypoparathyroidism is a disease characterized by inadequately low circulating concentrations of parathyroid hormone (PTH) resulting in low calcium levels and increased phosphate levels in the blood. Symptoms of the disease result from increased neuromuscular irritability caused by hypocalcaemia and include tingling, muscle cramps and seizures. The most common cause of the disease is inadvertent removal of, or injury to, the parathyroid glands during neck surgery, followed by genetic, idiopathic and autoimmune aetiologies. Conventional treatment includes activated Vitamin D and/or calcium supplements, but this treatment does not fully replace the functions of PTH and can lead to short-Term problems (such as hypocalcaemia, hypercalcaemia and increased urinary calcium excretion) and long-Term complications (which include nephrocalcinosis, kidney stones and brain calcifications). PTH replacement has emerged as a new treatment option. Clinical trials using human PTH(1-34) and PTH(1-84) showed that this treatment was safe and effective in studies lasting up to 6 years. Recombinant human PTH(1-84) has been approved in the United States and Europe for the management of hypoparathyroidism; however, its effect on long-Term complications is still being evaluated. Clinical practice guidelines, which describe the consensus of experts in the field, have been published and recognize the need for more research to optimize care. In this Primer, we summarize current knowledge of the prevalence, pathophysiology, clinical presentation and management of hypoparathyroidism.
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U2 - 10.1038/nrdp.2017.55
DO - 10.1038/nrdp.2017.55
M3 - Article
C2 - 28857066
AN - SCOPUS:85028661341
SN - 2056-676X
VL - 3
JO - Nature Reviews Disease Primers
JF - Nature Reviews Disease Primers
M1 - 17055
ER -