Management of Primary Hypoparathyroidism
A Single Centre Audit
S Sighakoli, T Wheatley
INTRODUCTION
Primary hypoparathyroidism is an uncommon endocrine disorder characterized by hypocalcaemia associated with an
inappropriately low parathyroid hormone concentration. European guidelines1 state that
• all patients should have individualised targets for calcium and phosphate
• relevant biochemical variables should be monitored at least annually
• quality of life should be evaluated
• patients should be taught to recognise hypocalcaemia and hypercalcaemia
• patients should be educated regarding potential complications
METHODS
A local retrospective audit of 18 patients aged 25 to 85 years with primary hypoparathyroidism was undertaken. Data were
obtained from clinical notes, a computerised endocrine database and local pathology system. Patients with end stage renal
disease or less than one year follow-up were excluded.
RESULTS
-16/18 patients were female
-No patient received education
regarding identifying symptoms of
abnormal Calcium levels
-50% had hyperphosphataemia
Aetiology for
Thyroidectomy
Combination
Treatment (Calcium &
Vitamin D Analogues)
Graves
2
1
14
Idiopathic
3
Goitre
9
Treatment of
abnormal Calcium
levels
14
12
12
12
10
10
8
8
5
6
6
4
Miscellaneous
4
1
2
0
Yes
18
15
12
9
6
3
0
15
15
No
14
20
16
16
11
3
3
3
2
4
Yes
No
Phosphate
Yes
No
Yes
Magnesium
CONCLUSIONS
There is scope to improve the
management of hypoparathyroidism
mainly in the regular monitoring of
biochemical variables.
Although guidelines are not based
on strong evidence, they at least
provide a useful follow up strategy
and identify clear targets.
0
No
Vitamin D
Yes
No
24 hour Calcium
RECOMMENDED
CHECKLIST
0.25-2 mcg
0.5-4 mcg
Vitamin D
400-800 IU/day
No
Yes
Calcium Phosphate
Product
No
Calcium
Serum Calcium , Phosphate,
Magnesium, Vitamin D, Renal function
Calcium phosphate product
(Target < 4.4)
24 hour urine calcium
(Target Males< 7.5, Females< 6.25)
Quality of Life
(six monthly)
Combination treatment
Calcitriol OR
Alphacalcidiol
Yes
Outpatient monitoring
Yes
No
Phosphate
Frequency
6 monthly
6 monthly
Annually
6 monthly
Education on hypo and hypercalcaemia
Elemental calcium
800 - 2000 mg
Ultrasound Renal Tract
Reference
1. European Society of Endocrinology Clinical Guideline: Treatment of chronic hypoparathyroidism in adults.
Eur J Endocrinol 2015 Aug;173(2):G1-20. doi: 10.1530/EJE-15-0628.
Bone and calcium
Sameer Sighakoli
2
4
0
0
No
7
8
8
N/A
20
12
4
No
Target Levels Stated
12
Calcium
BES2016
Yes
18
16
16
Yes
51--P
N/A
Other Measurements /
Calculations Undertaken
15
3
2
2
0
Annual Blood Monitoring
13
Poster
presented at:
DOI: 10.3252/pso.eu.BES2016.2016
5 yearly