Department of Endocrinology, Medical Centre of Postgraduate Medical Education, Bielanski Hospital, Warsaw, Poland.
Department of Oncologic Endocrinology and Nuclear Medicine, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
Endokrynol Pol. 2023;74(5):447-467. doi: 10.5603/ep.96950.
Over the past few years, there have been significant advances in our understanding of hypoparathyroidism (HypoPT) in terms of its epidemiology, clinical presentation, etiology, and skeletal and renal complications. Moreover, the available treatment options for HypoPT have changed. This position statement of the Expert Group of the Polish Society of Endocrinology summarizes the current state of knowledge and provides recommendations for optimal management to assist clinicians in the diagnosis, treatment, and monitoring of HypoPT in Poland. The specific aspects of HypoPT management in children, pregnant and lactating women, and patients with chronic kidney disease are also discussed. HypoPT is a rare disorder characterized by hypocalcemia and the lack or deficiency of parathyroid hormone (PTH). Hypoparathyroidism can be associated with complications, including nephrocalcinosis, nephrolithiasis, renal insufficiency, cataract, seizures, cardiac arrhythmia, depression, and an increased risk of infection. Minimizing complications of HypoPT requires careful evaluation and close monitoring of laboratory parameters. Conventional management of HypoPT has focused on maintaining serum calcium levels using oral calcium and active vitamin D. However, this approach is limited because it does not restore normal PTH function, is often associated with inadequate biochemical control, and raises concerns as to long-term side effects. HypoPT is the only classic endocrine insufficiency that is not commonly treated with the substitution of the missing hormone. Recently, recombinant human PTH(1-84) has become available, offering hope that the use of the missing hormone in the treatment of HypoPT will help achieve better control and reduce the risk of complications. However, this treatment is currently unavailable in Poland.
在过去的几年中，我们在理解甲状旁腺功能减退症（HypoPT）方面取得了重大进展，包括其流行病学、临床表现、病因以及骨骼和肾脏并发症。此外，HypoPT 的可用治疗选择也发生了变化。波兰内分泌学会专家组的这份立场声明总结了目前的知识状况，并提供了优化管理的建议，以帮助临床医生在波兰诊断、治疗和监测 HypoPT。还讨论了儿童、孕妇和哺乳期妇女以及慢性肾脏病患者的 HypoPT 管理的具体方面。HypoPT 是一种罕见的疾病，其特征是低钙血症和甲状旁腺激素（PTH）缺乏或不足。HypoPT 可伴有并发症，包括肾钙质沉着症、肾结石、肾功能不全、白内障、癫痫发作、心律失常、抑郁和感染风险增加。最大限度地减少 HypoPT 的并发症需要仔细评估和密切监测实验室参数。HypoPT 的常规治疗方法集中在使用口服钙和活性维生素 D 来维持血清钙水平。然而，这种方法存在局限性，因为它不能恢复正常的 PTH 功能，通常与生化控制不足有关，并引起对长期副作用的担忧。HypoPT 是唯一一种未普遍用替代缺失激素治疗的经典内分泌功能减退症。最近，重组人 PTH(1-84) 已可获得，这为使用缺失激素治疗 HypoPT 以帮助实现更好的控制和降低并发症风险带来了希望。然而，这种治疗目前在波兰还不可用。
