Paresthesia, Muscle Spasms, and Cramps: Unraveling the Hypocalcemia Puzzle in Hypoparathyroidism

Video Transcription

Video Summary

This webinar, led by Drs. Inderpreet Madihar and Alia Khan, focused on hypoparathyroidism—a condition characterized by low parathyroid hormone (PTH) levels—and its complications, particularly hypocalcemia, muscle spasms, and paresthesia. The discussion addressed diagnostic criteria, emphasizing the need for two separate episodes of hypocalcemia alongside low or inappropriately normal PTH levels. The speakers highlighted various complications including renal issues (nephrolithiasis, nephrocalcinosis, chronic kidney disease), neurological effects (basal ganglia calcifications, seizures, cognitive deficits), cardiovascular risks (QT prolongation, hypertension), and skeletal abnormalities characterized by increased bone mass but reduced bone quality.<br /><br />Management revolves around maintaining serum calcium in a tight range to avoid hypocalcemia or hypercalcemia and preserving renal function through close monitoring of calcium, phosphate, magnesium, and vitamin D levels. Conventional therapy includes calcium supplementation and active vitamin D analogs; however, pregnancy requires especially careful monitoring due to fetal development risks and placental production of PTH-related peptide.<br /><br />The panel discussed novel treatments, particularly long-acting PTH analogs like palopectaryparotide, which has shown promise in phase 2 and 3 trials by reducing the need for calcium and vitamin D supplements, decreasing urinary calcium excretion, improving renal function, normalizing bone remodeling, and enhancing quality of life. Questions addressed challenges in patients with chronic kidney disease, vitamin D resistance, and insurance coverage for PTH therapies. The experts underscored the importance of individualized therapy guided by evidence-based protocols to optimize outcomes, minimize complications, and improve quality of life for patients with chronic hypoparathyroidism.

Keywords

hypoparathyroidism

parathyroid hormone

hypocalcemia

muscle spasms

paresthesia

renal complications

neurological effects

cardiovascular risks

bone abnormalities

PTH analogs