Hypoparathyroidism
What is it?
Hypoparathyroidism is a condition in which the parathyroid glands fail to produce enough parathyroid hormone, resulting in hypocalcaemia. The parathyroid glands are glands located in the neck that produce a hormone (parathyroid hormone or parathormone) that is needed to control calcium, phosphorus and vitamin D levels in the blood and hence to mantain bone health. Early diagnosis can limit the side effects of chronic hypoparathyroidism. The most common cause of hypoparathyroidism is damage to the parathyroid glands after thyroid surgery. Much less commonly, hypoparathyroidism can result from an autoimmune disease or congenital disorders (e.g. DiGeorge syndrome).
Which are the symptoms?
Symptoms of hypoparathyroidism include muscle cramps, muscle spasms, widespread pain, tingling in the lips, fingers and toes, abdominal pain and difficulty concentrating.
How is it diagnosed?
The diagnosis of hypoparathyroidism is made on the basis of haematochemical tests to assess calcium, phosphorus, magnesium and parathormone levels. Signs of Chvostek (ipsilateral contraction of all or some muscles innervated by the facial nerve, with lateral deviation of the lip arch and nasal fin towards the stimulation) and Trousseau (wrist spasm caused by radial artery ischaemia when the sphygmomanometer cuff is placed on the patient's arm) may occur in hypocalcaemia.
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How is it treated?
The aim of treatment of hypoparathyroidism is to rebalance calcium and phosphorus concentrations and is based on the administration of active vitamin D supplements (such as calcitriol) and calcium salts (such as calcium carbonate). A concomitant condition of hypovitaminosis D should be treated with cholecalciferol to maintain 25OH vitamin D level ≥ 30 ng/ml to ensure pleiotropic action of this hormone. Intravenous calcium administration may be indicated in cases of severe symptomatic hypocalcaemia. Therapy with parathormone analogue molecules may be indicated in cases where good disease control cannot be achieved by conventional therapy (oral calcium and vitamin D).
Where do we treat it?
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