Clinical profile of patients with chronic hypoparathyroidism according to the All-Russian registry

BACKGROUND. Chronic hypoparathyroidism (HypoPT) is a rare endocrine disorder that requires lifelong multi-component therapy. The goal of HypoPT treatment is to reach the target values of the main indicators of calcium-phosphorus metab olism, first of all — calciemia, as well as to prevent acute and delayed complications, including pathology of kidneys, eyes, brain and other organs. One of the ways to improve the quality of medical care, determine optimal clinical and therapeutic management strategies, and find prognostic markers for HypoPT is to analyze large databases. This approach allows not only a better understanding of the peculiarities of disease progression, but also the evaluation of the efficacy of different therapeutic regimens.

AIM. To evaluate the clinical and biochemical profile, medication therapy, and long-term complications in patients with chronic postoperative and nonsurgical HypoPT according to the data of the Russian Registry.

MATERIALS AND METHODS. The observational, continuous study was based on the data of the Russian Registry of Patients with Chronic Postoperative and Nonsurgical HypoPT; 1776 patients from 81 regions of the Russian Federation were included in the study. RESULTS. In the study population, chronic HypoPT was predominant in women (86.5%), most patients had a postoperative etiology of the disease (70.1%), with the most common development of chronic postoperative HypoPT due to neck surgery for highly differentiated thyroid cancer (44.1%). Target calciemia was achieved in 44.6% of patients and target phosphatemia in 54.7%. Structural renal pathology (nephrocalcinosis/nephrolithiasis) was observed in 33.4% and 10.7% of patients, re spectively, and a decrease in glomerular filtration rate to chronic kidney disease stages 3a-5 in 17.4% of patients. Cataract occurred in 34.7%. In general, bone mineral density in the main zones (lumbar spine, femur, and radius) was within the values expected for the age of patients with both postoperative and nonsurgical HypoPT, and there was no evidence of high bone density phenomenon. The trabecular bone index corresponded to normal bone microarchitecture. 70.4% of patients re ceived classical HypoPT therapy — a combination of preparations of active metabolites of vitamin D and calcium. Additional medications (magnesium, potassium, recombinant human PTH, thiazide diuretics) were present in 5.9% of patients.

CONCLUSION. Currently, there are limited epidemiologic data on the prevalence and morbidity of HypoPT in the Russian Federation, mainly due to the lack of nosology in the official statistical forms. The study of anamnestic, laboratory and in strumental characteristics of HypoPT in patients of the Russian population is an important step on the way to optimize the treatment and diagnosis of the disease. The analysis shows that the laboratory control of the disease is inadequate, as well as the coverage of patients with regard to the screening for long-term complications. Improving current clinical guidelines and raising awareness among physicians and patients can help overcome this problem.

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