Diagnosis and management of hypocalcemia
- 4 May 2020
- journal article
- review article
- Published by Springer Science and Business Media LLC in Endocrine
- Vol. 69 (3), 485-495
- https://doi.org/10.1007/s12020-020-02324-2
Abstract
The aim of this clinical narrative review is to summarize and critically appraise the literature on the differential diagnosis of hypocalcemia and to provide its correct management. Calcium is essential for muscle contraction and neurotransmitter release, but clinical manifestations of hypocalcaemia (serum calcium level <8 mg/dl; 2.12 mmol/L) may involve almost any organ and system and may range from asymptomatic to life-threating conditions. Disorders causing hypocalcemia can be divided into parathyroid hormone (PTH) and non-PTH mediated. The most frequent cause of hypocalcemia is postsurgical hypoparathyroidism, while a more comprehensive search for other causes is needed for appropriate treatment in the non PTH-mediated forms. Intravenous calcium infusion is essential to raise calcium levels and resolve or minimize symptoms in the setting of acute hypocalcemia. Oral calcium and/or vitamin D supplementation is the most frequently used as treatment of chronic hypocalcemia. In hypoparathyroidism, providing the missing hormone with the use of the recombinant human (rh) PTH(1–84) has been recently approved both by the Food and Drug Administration (FDA) and the European Medicines Agency (EMA). This new therapy has the advantage of being effective for correcting serum calcium levels and significantly reducing the daily requirements of calcium and active vitamin D supplements. However, due to the high cost, a strict selection of candidates to this therapy is necessary. More challenging is the long-term hypocalcemia treatment, due to its associated complications. The development of long-acting recombinant human PTH will probably modify the management of chronic hypoparathyroidism in the future.This publication has 67 references indexed in Scilit:
- Prevalence and risk factors for hypoparathyroidism following total thyroidectomy in Spain: a multicentric and nation-wide retrospective analysisEndocrine, 2019
- The relative influence of serum ionized calcium and 25-hydroxyvitamin D in regulating PTH secretion in healthy subjectsBone, 2019
- Correlation between iPTH levels on the first postoperative day after total thyroidectomy and permanent hypoparathyroidism: our experienceOpen Medicine, 2019
- Hypocalcemic disordersBest Practice & Research Clinical Endocrinology & Metabolism, 2018
- The Epidemiology of Hypoparathyroidism in Italy: An 8-Year Register-Based StudyCalcified Tissue International, 2016
- Epidemiology and Diagnosis of HypoparathyroidismJournal of Clinical Endocrinology & Metabolism, 2016
- The diagnosis and management of hypercalcaemiaBMJ, 2015
- Investigating hypocalcaemiaBMJ, 2013
- Cardiovascular and renal complications to postsurgical hypoparathyroidism: A Danish nationwide controlled historic follow-up studyJournal of Bone and Mineral Research, 2013
- Interpretation of Serum Calcium in Patients with Abnormal Serum ProteinsBMJ, 1973