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01-09-2020 | Hypoparathyroidism | Review

Diagnosis and management of hypocalcemia

Authors: Jessica Pepe, Luciano Colangelo, Federica Biamonte, Chiara Sonato, Vittoria Carmela Danese, Veronica Cecchetti, Marco Occhiuto, Valentina Piazzolla, Viviana De Martino, Federica Ferrone, Salvatore Minisola, Cristiana Cipriani

Published in: Endocrine | Issue 3/2020

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.

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Title: Diagnosis and management of hypocalcemia
Authors: Jessica Pepe
Luciano Colangelo
Federica Biamonte
Chiara Sonato
Vittoria Carmela Danese
Veronica Cecchetti
Marco Occhiuto
Valentina Piazzolla
Viviana De Martino
Federica Ferrone
Salvatore Minisola
Cristiana Cipriani
Publication date: 01-09-2020
Publisher: Springer US
Keywords: Hypoparathyroidism
Hypocalcemia
Published in: Endocrine / Issue 3/2020
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI: https://doi.org/10.1007/s12020-020-02324-2

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