Survey Assesses Expert Practices for Monitoring Hypoparathyroidism
70 respondents were surveyed on follow-up care for patients in study
Most experts report similar practices for how they monitor blood and urine tests in people with chronic hypoparathyroidism, but monitoring practices for disease complications like kidney or bone problems are more variable, a new study reports.
“While [blood] and urine measurements are completed consistent with published guidelines and consensus statements, the assessment for complications of chronic [hypoparathyroidism] varies considerably, identifying areas for future research,” the scientists wrote.
The study, “Initial Assessment and Monitoring of Patients with Chronic Hypoparathyroidism: a Systematic Current Practice Survey,” was published in the Journal of Bone and Mineral Research.
Chronic hypoparathyroidism is caused by low levels of the parathyroid hormone, which leads to low levels of calcium and and high levels of phosphorus in the blood. Medical care for this rare condition generally involves trying to normalize mineral levels and minimize the impact of symptoms on a person’s quality of life.
It’s generally recommended patients with hypoparathyroidism undergo regular monitoring, but there’s little published data on what kinds of monitoring strategies are useful in this population. A team of international researchers conducted a survey of medical experts in the field (endocrinologists, nephrologists, and surgeons) to learn more.
“The objective of the present survey was to use a systematic approach to describe the current practice of monitoring of chronic [hypoparathyroidism],” the scientists wrote.
A total of 70 experts responded to the survey; most practiced in Europe or North America, and the majority had been caring for patients for more than two decades.
When assessing new patients, most experts said they performed blood and urine analyses to check levels of calcium and other relevant substances. Most also used kidney imaging (with a CT scan, an ultrasound or X-ray) to check for abnormal mineral deposits in the kidney (such as kidney stones), and the majority screened for anxiety and depression in most patients.
In terms of long-term monitoring, most of the experts said they performed blood and urine tests to check levels every six months or less frequently. Regular screening for mental health issues also was generally done on a similar timetable. Monitoring was typically done more frequently in patients with less stable disease.
Practices for monitoring for other health complications of hypoparathyroidism — for example, kidney imaging, tests of bone health, or eye exams — “vary considerably amongst respondents but are rarely completed on a monthly basis,” the researchers noted. They pointed out differences in monitoring for these complications may contribute to variability in their distribution and determinants in the scientific literature.
Assessment and monitoring practices were generally comparable regardless of whether or not hypoparathyroidism had developed following surgery.
A separate group of experts reviewed the data and created some general guidelines for assessing and monitoring patients. These guidelines are generally in line with the practices reported, suggesting, for example, initial blood and urine tests with regular monitoring every few months. The panel also noted that it’s a good idea to recheck calcium levels a few days after making any change in treatment.