| ObjectiveTo analyse the clinical characteristics of different types of hypoparathyroidism and analyse complications as well as related factors in order to deepen physicians'understanding of the disease and reduce misdiagnosis and missed diagnosis.MethodsThe inpatient clinical data of hypoparathyroidism patients first treated in Tianjin Medical University General Hospital from Jan.2001 to Jul.2017 were collected and analyzed retrospectively.ResultsA total of 129 hypoparathyroidism patients were included and devided into 3 groups according to etiology,in which 17 cases were pseudo-hypoparathyroidism(PHP),82 cases were idiopathic hypoparathyroidism(IHP),and 30 cases were postsurgical hypoparathyroidism(PHypo).The median age of onset was 13(9.5?20),26(16?42)and 49(32?57.5)years old,P<0.001.The duration of PHP and IHP were longer compared with PHypo[7.0(1.0?12.5)years;4.5(2.0?15.5)years vs.0.17(0.03?5.5)years,P=0.001].And the rate of misdiagnosis or missed diagnosis were higher(35.3%;30.5%vs.0%,P<0.001).Most patients take tetany as the first episode symptom with PHP the most prominent.Other clinical manifestations include paresthesia,seizure,fatigue,hypophrenia and Chvostek's sign,Trousseau's sign,ectodermal dysplasia,showing no significant difference among three groups.In the aspect of biochemical features,compared with IHP and PHypo,PHP patients had higher serum parathyroid hormone(PTH)level[23.5(15.3?50.3)pmol/L vs.0.32(0.32?1.48)pmol/L;0.32(0.32?1.49)pmol/L,P<0.001];lower urine calcium level[0.61(0.33?2.16)mmol/24h vs.1.88(1.02?5.17)mmol/24h;3.51(1.64?5.66)mmol/24h,P=0.003];higher bone turnover marker,osteocalcin(OC)level(54.8±48.8 ng/ml vs.19.7±13.8ng/ml;13.3±4.2ng/ml,P=0.003);higher bone formation marker,Procollagen 1 N-terminal Peptide(P1MP)level(107.96±40.55 ng/ml vs.50.04± 19.51 ng/ml;36.62± 19.00 ng/ml,P<0.001);higher bone resorption marker,crosslinked collagen(CROSSL)level(1.40±0.85ng/ml vs.0.57±0.56 ng/ml;0.28±0.14ng/ml,P? 0.023).Compared with PHypo,PHP and IHP had higher serum inorganic phosphorus level(1.92±0.45 mmol/L;1.80±0.57 mmol/L vs.1.52±0.45 mmol/L,P=0.02).As for complications,IHP patients had higher femoral neck bone mineral density(FNBMD)compared with PHP and PHypo(1.008±0.163 g/cm2 vs.0.902±0.139 g/cm2;0.899±0.156 g/cm2).No significant difference was found in lumbar spine bone mineral density(LSBMD).On multiple linear regression analysis,FNBMD showed positive association with duration(P=0.033)and inverse association with P1NP(P=0.02).LSBMD showed positive association with duration(P=0.018).Prevalence of intracranial calcification were respectively 80.0%(12/15),44.7%(21/47),10.0%(1/10),P=0.002.Through the Binary Logistic Analysis,duration of disease emerged as the independent risk factor of intracranial calcification,high serum calcium emerged as the protective factor of intracranial calcification,and tetany emerged as the predictor of intracranial calcification.In addition,duration appears to be the independent risk factor of cataract.ConclusionClinical characteristics were similar but order of severity was different among different types of hypoparathyroidism.Very high prevalence of early misdiagnosis and missed diagnosis of PHP and IHP was found in clinical practice.Complications including high BMD,intracranial calcification and cataract showed significant positive association with duration.Earlier diagnosis and regular treatment of hypoparathyroidism were the critical factors to reduce complications and improve quality of life. |
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