Hypoparathyroidism ( Endocrinology ) ...

Hypoparathyroidism

1. Hypoparathyroidism

2. Anatomy of parathyroid gland The  parathyroid glands  are usually located on the posterior aspect of the  thyroid gland . They are flattened and oval in shape – situated external to the thyroid gland itself but within the pretracheal fascia. Arterial supply is chiefly via the  inferior thyroid artery Venous drainage is into the  superior ,  middle , and  inferior thyroid veins . lymphatic drainage from the parathyroid glands is to the  paratracheal  and  deep cervical nodes . The parathyroid glands have an extensive supply of sympathetic nerves derived from  thyroid branches  of the cervical ganglia.

3. Physiology of PTH

4. What is Hypoparathyroidism? A condition where the parathyroid glands produce insufficient parathyroid hormone (PTH)

5. Causes of Hypoparathyroidism

6. Signs and Symptoms of Hypoparathyroidism

7. Diagnosis Blood tests: Calcium, phosphorus, PTH levels Medical history and physical examination Other tests that may be ordered include: Electrocardiogram (ECG) to check for an abnormal heart rhythm Computed tomography (CT) scan to check for calcium deposits in the Brain 24 hr Urine calcium test

8. Complications of Untreated Hypoparathyroidism Accurate diagnosis and treatment might prevent these complications or keep them from getting worse. But once they occur, taking calcium and vitamin D usually doesn't reverse the damage. Irreversible complications include: Hardening and changes in the shape of bones, and poor growth Delayed mental development in children Calcium deposits in the brain, which can cause balance problems, movement disorders and seizures cataracts Teeth that don't form properly, affecting dental enamel and roots, which can happen when hypoparathyroidism occurs at an early age when teeth are developing(dental hypoplasia)

9. Treatment Options Treatment of patients with hypoparathyroidism involves correcting the hypocalcemia by administering calcium and vitamin D. Guidelines on chronic hypoparathyroidism by the European Society of Endocrinology, released in 2015, are below:  [21 ] Consider a diagnosis of chronic hypoparathyroidism ( HypoPT ) in a patient with hypocalcemia and inappropriately low parathyroid hormone (PTH) levels. Consider genetic testing and/or family screening in a patient with HypoPT of unknown etiology. Treatment targeted to maintain serum calcium level (albumin adjusted total calcium or ionized calcium) in the lower part or slightly below the lower limit of the reference range (target range) is suggested, with patients being free of symptoms or signs of hypocalcemia . Treat patients with chronic HypoPT with symptoms of hypocalcemia and/or an albumin adjusted serum calcium level < 2.0  mmol /L (< 8.0 mg/ dL /ionized serum calcium levels [S- Ca   2 ] < 1.00  mmol /L). Offer treatment to asymptomatic patients with chronic HypoPT and an albumin adjusted calcium level between 2.0  mmol /L (8.0 mg/ dL /S- Ca   2+  1.00  mmol /L) and the lower limit of the reference range in order to assess whether this may improve their well-being. Use activated vitamin D analogues plus calcium supplements in divided doses

10. If activated vitamin D analogues are not available, treat with calciferol (preferentially cholecalciferol ). Titrate activated vitamin D analogues or cholecalciferol in such a manner that patients are without symptoms of hypocalcemia and serum calcium levels are maintained within the target range. Provide vitamin D supplementations in a daily dose of 400–800 IU to patients treated with activated vitamin D analogues. In a patient with hypercalciuria , consider a reduction in calcium intake, a sodium-restricted diet, and/or treatment with a thiazide diuretic. In a patient with renal stones, evaluate renal stone risk factors and management according to relevant international guidelines. In a patient with hyperphosphatemia and/or an elevated calcium-phosphate product, consider dietary interventions and/or adjustment of treatment with calcium and vitamin D analogues. In a patient with hypomagnesemia , consider measures that may increase serum magnesium levels.

11. Patient Management What is the aim of  treatment in hypoparathyroidism ? The aim of treatment is to abolish symptoms, not to restore ‘normal’ calcium levels in the blood. This means that you need to keep your calcium levels high enough to avoid symptoms of hypocalcaemia but low enough to avoid causing problems with the kidneys. Importance of regular check-ups Dietary considerations (calcium-rich foods) Medication adherence

12. Resources Davidsons principle of medicine Research gate medscape