eMedicine Specialties > Pediatrics: General Medicine > Endocrinology
Hypoparathyroidism: Follow-up
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for at least 24 hours after intravenous calcium withdrawal (Rebound hypocalcemia can occur when intravenous calcium is withdrawn, even on adequate amounts of oral calcium.)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 |
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References
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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
Follow-up: Hypoparathyroidism