Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Windisch, J.
Hypoparathyroidism – renal and skeletal manifestations
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2022. pp. 84
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Amrein Karin
- Tmava-Berisha Adelina
- Altmetrics:
- Abstract:
- Background Hypoparathyroidism (hypoPT) is a two-hormone deficiency syndrome: parathyroid hormone (PTH) and active vitamin D are reduced. Damage, removal, or genetic defects of parathyroid glands cause chronically low PTH levels and consequently hypocalcaemia and hyperphosphatemia. HypoPT can manifest in many organ systems, especially kidney and bone that are studied in this thesis. It remains the last endocrinopathy that is not usually treated with the lacking hormone. Methods This retrospective observational study included patients with chronic postsurgical hypoPT (pshypoPT) and nonsurgical hypoPT (nshypoPT), treated at the Medical University of Graz. Patients were identified via openMEDOCS and included with PTH levels below 30pg/mL and hypocalcaemia. Renal and skeletal outcomes were assessed. Furthermore, a literature research was conducted. Results 191 patients were identified, 156 pshypoPT and 35 nshypoPT. Mean disease duration was 9.1 years. 11 patients received rhPTH 1-84 replacement therapy. The mean age was 61.7 years, patients with pshypoPT were older compared to nshypoPT (mean 64.7 vs. 48.5 years, p<0.001). 70% were women. They were more likely to have pshypoPT than nshypoPT (86.5% vs. 70.7% p=0.01, OR 2.65). Kidney function was slightly impaired (mean eGFR 61.2 mL/min/1.7m2) and patients with pshypoPT had significantly lower eGFR than those with nshypoPT (59.1 vs 72.8 mL/min/1.7m2, p=0.02). Renal calcification was documented more often in patients with nshypoPT compared to pshypoPT (17.1% vs. 5.1%, p=0.025, OR 3.83). Despite younger age, more patients with nshypoPT had a history of fractures (28.6% vs. 12.2%, p=0.33, OR 2.88), specifically, femur and other lower extremity fractures (11.4% vs. 0.6% p=0.004 and 17.1% vs. 3.2% p=0.006 respectively). Overall, 53 fractures were documented for the cohort. Mean T Scores were 0.75 (lumbar spine) and 0.13 (proximal femur). They did not differ between both groups. Conclusion Chronic hypoPT is a complex disease that can present with a variety of symptoms and complications. In our retrospective observational study of a tertiary center including 156 pshypoPT and 35 nshypoPT, we found a high renal and skeletal morbidity, particularly in nshypoPT. Further studies are required to optimize treatment and lower the risk for adverse outcomes in these patients.