Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain.
Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
Front Endocrinol (Lausanne). 2024 Sep 25;15:1464515. doi: 10.3389/fendo.2024.1464515. eCollection 2024.
The identification of patients with chronic hypoparathyroidism who are adequately (AC) or not adequately controlled (NAC) has clinical interest, since poor disease control is related to complications and mortality. We aimed to assess the prevalence of NAC patients in a cohort of subjects with postsurgical hypoparathyroidism.
We performed a multicenter, retrospective, cohort study including patients from 16 Spanish hospitals with chronic hypoparathyroidism lasting ≥3 years. We analyzed disease control including biochemical profile and clinical wellness. For biochemical assessment we considered three criteria: criterion 1, normal serum calcium, phosphorus and calcium x phosphorus product; criterion 2, the above plus estimated glomerular filtration rate ≥60 ml/min/1.73 m; and criterion 3, the above plus normal 24-hour urinary calcium excretion. A patient was considered AC if he or she met the biochemical criteria and was clinically well.
We included 337 patients with postsurgical hypoparathyroidism (84.3% women, median age 45[36-56] years, median time of follow-up 8.9[6.0-13.0] years). The proportions of NAC patients with criteria 1, 2 and 3 were, respectively, 45.9%, 49.2% and 63.1%. Patients who had dyslipidemia at the time of diagnosis presented a significantly higher risk of NAC disease (criterion 3; OR 7.05[1.44-34.45]; P=0.016). NAC patients (criterion 2) had a higher proportion of subjects with incident chronic kidney disease and eye disorders, and NAC patients (criterion 3) had a higher proportion of incident chronic kidney disease, nephrolithiasis and dyslipidemia than AC patients.
The present study shows a strikingly high prevalence of NAC patients in the clinical practice of Spanish endocrinologists. Results suggest that NAC disease might be associated with some prevalent and incident comorbidities.
识别慢性甲状旁腺功能减退症患者中控制良好（AC）和控制不佳（NAC）的患者具有临床意义，因为疾病控制不佳与并发症和死亡率有关。我们旨在评估手术后甲状旁腺功能减退症患者队列中 NAC 患者的患病率。
我们进行了一项多中心、回顾性队列研究，纳入了来自 16 家西班牙医院的慢性甲状旁腺功能减退症持续≥3 年的患者。我们分析了包括生化特征和临床健康状况在内的疾病控制情况。对于生化评估，我们考虑了三个标准：标准 1，血清钙、磷和钙 x 磷乘积正常；标准 2，上述标准加上估计肾小球滤过率≥60ml/min/1.73m；标准 3，上述标准加上正常 24 小时尿钙排泄量。如果患者符合生化标准且临床状况良好，则认为其控制良好。
我们纳入了 337 例手术后甲状旁腺功能减退症患者（84.3%为女性，中位年龄 45[36-56]岁，中位随访时间 8.9[6.0-13.0]年）。符合标准 1、2 和 3 的 NAC 患者比例分别为 45.9%、49.2%和 63.1%。诊断时患有血脂异常的患者发生 NAC 疾病的风险显著增加（标准 3；OR 7.05[1.44-34.45]；P=0.016）。NAC 患者（标准 2）中患有慢性肾脏病和眼部疾病的患者比例较高，NAC 患者（标准 3）中患有慢性肾脏病、肾结石和血脂异常的患者比例高于 AC 患者。
本研究显示，西班牙内分泌学家的临床实践中 NAC 患者的患病率极高。结果表明，NAC 疾病可能与一些常见和新发的合并症有关。
