According to a recent article from MedPage Today, new clinical guidelines involving parathyroidism were previewed at the American Society for Bone and Mineral Research (ASBMR) meeting last month.

Hypoparathyroidism

Hypoparathyroidism is a condition that is characterized by a low level of parathyroid hormone (PTH), which is necessary for balancing calcium and phosphorus in the body. Without this hormone, there is a low level of calcium in the bones and blood and an increased level of phosphorus in the blood.

Symptoms:

• Tingling and burning in the fingertips, toes, and lips
• Muscle aches and cramps in the legs, feet, abdomen, and face
• Twitching and spasms of the muscles around the mouth, hands, arms, and throat
• Fatigue
• Weakness
• Painful menstruation
• Patchy hair loss
• Dry, coarse skin
• Brittle nails
• Depression and anxiety

Hyperparathyroidism

Hyperparathyroidism is when the parathyroid glands create too much parathyroid hormone in the bloodstream. These glands, located behind the thyroid at the bottom of the neck, are about the size of a grain of rice.

Primary hyperparathyroidism -an enlargement of one or more of the parathyroid glands- causes overproduction of the hormone. This causes high calcium levels in the blood, which can cause a variety of health problems.

Secondary hyperparathyroidism occurs due to another disease that first causes low calcium levels in the body. Over time, increased parathyroid hormone levels occur.

Symptoms:

Hyperparathyroidism is often diagnosed before signs or symptoms of the disorder are apparent. When symptoms do occur, they’re the result of damage or dysfunction in other organs or tissues due to high calcium levels in the blood and urine or too little calcium in bones.

Symptoms may be so mild and nonspecific that they don’t seem related to parathyroid function, or they may be severe. The range of signs and symptoms include:

• Osteoporosis
• Kidney stones
• Excessive urination
• Abdominal pain
• Tiring easily or weakness
• Depression or forgetfulness
• Bone and joint pain
• Frequent complaints of illness with no apparent cause
• Nausea, vomiting, or loss of appetite

How These Guidelines Were Created

The new guidelines that were previewed were updated versions of the 2011 and 2013 ASBMR guidelines involving hypo- and hyperthyroidism. Furthermore, the guidelines were created with the help of expert opinions. Those involved in creating the guidelines surveyed practicing endocrinologists.

Panels Suggestion for Hypoparathyroidism

The panel members suggested that patients with hypoparathyroidism receive longstanding mainstays of treatment, calcium-bases supplements and vitamin D, and diuretics as well. This is recommended instead of parathyroid hormone (PTH) replacement.

Panel members still recognized the importance of PTH replacement, citing that evidence suggests it “probably” improves a patient’s quality of life slightly, and allows for patients to cut their calcium and vitamin supplements in half.

The guideline also discussed genetic testing, which was backed by experts. Genetic testing can be useful for patients with certain clinical and laboratory features. In addition, the guidelines suggested keeping calcium within a normal range, being sure to normalize phosphate, magnesium, and 25-(OH)D level. If all these treatments fail, then PTH replacement should be considered. Workshop co-chair, Aliya Khan, MD, of McMaster University in Hamilton, Ontario, also mentioned at the end of her presentation that new drug therapies are in development.

Panels Suggestion for Hyperthyroidism

For the treatment of hyperthyroidism, the panel suggested surgical treatment for patients irrespective of phenotype.

Co-chair John Bilezikian, MD, of Columbia University in New York City, took on the guidelines for hyperthyroidism. He emphasized that the treatment and diagnosis of this disease have gotten better over the years.

This condition affects females primarily, which affects how often people undergo biochemical screening. This means that there are more incidentally-discovered cases, which also means more asymptomatic patients are diagnosed.

For those diagnosed with primary hyperthyroidism, surgery is effective as a treatment. This type is defined by elevated PTH.

Once a patient is diagnosed, Bilezikian highlighted it is important to check for complications. Complications in the bone and kidneys are most common, and the guideline recommends dual energy X-ray absorptiometry testing and kidney function testing.

If a patient is not comfortable with surgery, there are other options for them. This includes bisphosphonates (to help reduce fractures), vitamin D supplementation, and cinacalcet (Sensipar).

At the end of his presentation, Bilezikian displayed an extensive research agenda, dependent on the clinical survey.