eMedicine Specialties > Pediatrics: General Medicine > Endocrinology

Hypoparathyroidism: Follow-up

Author: James CM Chan, MD, Professor of Pediatrics, University of Vermont College of Medicine; Director of Research, The Barbara Bush Children's Hospital, Maine Medical Center
Contributor Information and Disclosures

Updated: Sep 17, 2009

Follow-up

Further Outpatient Care

  • Close follow-up of serum calcium concentrations is required in the first months of hypoparathyroidism treatment; after the serum calcium and phosphate levels stabilize, monitor these serum data every 3-6 months. Therapeutic goal is to maintain serum calcium in the low-normal range to decrease risk for nephrocalcinosis.
  • Renal ultrasonographic studies are needed annually to assess for nephrocalcinosis development.

Inpatient & Outpatient Medications

  • 1,25-Dihydroxyvitamin D: This medication bypasses the parathyroid hormone (PTH)-dependent step of 1-alpha hydroxylation of 25 hydroxyvitamin D. It should be used in combination with a calcium supplement to maintain the calcium in the low normal range and serum phosphate concentrations in the mid range.
  • Calcium: Any of the oral calcium supplements may be used.

Complications

  • Nephrocalcinosis
  • Hypocalcemia-related events, including tetany, seizure, laryngospasm, arrhythmia, and syncope

Prognosis

  • Hypoparathyroidism is a chronic disease requiring strict compliance with medications. As with any chronic illness, compliance can be difficult to achieve with adolescents.
  • Nephrocalcinosis can lead to kidney damage requiring intervention.

Patient Education

  • Family members should recognize the signs of hypocalcemia.
  • During times of stress, such as surgery or significant intercurrent illness, inherited disorders of hypoparathyroidism that have seemingly resolved can be unmasked and require intervention.

Miscellaneous

Medicolegal Pitfalls

  • Failure to distinguish calcium receptor defects from hypoparathyroidism
  • Failure to consider an associated cardiac lesion in an infant with hypocalcemia
  • Failure to dilute intravenous calcium to no more than 2% solution for intermittent and continuous infusions to permit earlier recognition of tissue extravasation and decrease risk of tissue necrosis
  • Failure to monitor serum calcium concentrations for at least 24 hours after intravenous calcium withdrawal (Rebound hypocalcemia can occur when intravenous calcium is withdrawn, even on adequate amounts of oral calcium.)

Special Concerns

  • Children may be asymptomatic or report vague symptoms. Evaluation of a new onset seizure or movement disorder should include calcium concentration being checked.
 


More on Hypoparathyroidism

Overview: Hypoparathyroidism
Differential Diagnoses & Workup: Hypoparathyroidism
Treatment & Medication: Hypoparathyroidism
Follow-up: Hypoparathyroidism
Multimedia: Hypoparathyroidism
References

References

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  2. Ahonen P, Myllarniemi S, Sipila I, Perheentupa J. Clinical variation of autoimmune polyendocrinopathy-candidiasis- ectodermal dystrophy (APECED) in a series of 68 patients. N Engl J Med. Jun 28 1990;322(26):1829-36. [Medline].

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Further Reading

Keywords

hypoparathyroidism, hypocalcemia, pseudohypoparathyroidism, PHP, pseudopseudohypoparathyroidism, PPHP, polyglandular autoimmune endocrinopathy, DiGeorge syndrome, Barakat syndrome, Kenny-Caffey syndrome, Albright hereditary osteodystrophy, parathyroid insufficiency, familial hypercalciuric hypocalcemia, familial isolated hypoparathyroidism, calcium-sensing receptor hypocalcemia, Kearns-Sayre syndrome, Pearson marrow pancreas, laryngospasm, syncope, seizure, tetany, muscle aches, facial twitching, carpopedal spasm, tetralogy of Fallot, truncus arteriosus, Albright hereditary osteodystrophy, AHO, obesity, treatment, diagnosis

Contributor Information and Disclosures

Author

James CM Chan, MD, Professor of Pediatrics, University of Vermont College of Medicine; Director of Research, The Barbara Bush Children's Hospital, Maine Medical Center
James CM Chan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Association of University Professors, American Chemical Society, American Heart Association, American Medical Association, American Physiological Society, American Society for Bone and Mineral Research, American Society of Nephrology, American Society of Pediatric Nephrology, International Society of Nephrology, New York Academy of Sciences, Society for Experimental Biology and Medicine, and Southern Society for Pediatric Research
Disclosure: Nothing to disclose.

Medical Editor

Thomas A Wilson, MD, Professor of Clinical Pediatrics, Department of Pediatrics; Director of Pediatric Endocrinology, Division of Pediatric Endocrinology, Department of Pediatrics, State University of New York at Stony Brook
Thomas A Wilson, MD is a member of the following medical societies: Endocrine Society, Lawson-Wilkins Pediatric Endocrine Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London), Professor and Chair, First Department of Pediatrics, Athens University Medical School, Aghia Sophia Children's Hospital, Greece
George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London) is a member of the following medical societies: American Academy of Pediatrics, American College of Endocrinology, American College of Physicians, American Pediatric Society, American Society for Clinical Investigation, Association of American Physicians, Endocrine Society, Lawson-Wilkins Pediatric Endocrine Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences
Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Chief Editor

Stephen Kemp, MD, PhD, Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas and Arkansas Children's Hospital
Stephen Kemp, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Pediatric Society, Endocrine Society, Phi Beta Kappa, Southern Medical Association, and Southern Society for Pediatric Research
Disclosure: Genentech, Inc. Honoraria Speaking and teaching; Pfizer, Inc. Honoraria Consulting

 
 
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