Epidemiology and Health-Related Quality of Life in Hypoparathyroidism in Norway

Marianne C Astor, Kristian Løvås, Aleksandra Debowska, Erik F Eriksen, Johan A Evang, Christian Fossum, Kristian J Fougner, Synnøve E Holte, Kari Lima, Ragnar B Moe, Anne Grethe Myhre, E Helen Kemp, Bjørn G Nedrebø, Johan Svartberg, Eystein S Husebye, Marianne C Astor, Kristian Løvås, Aleksandra Debowska, Erik F Eriksen, Johan A Evang, Christian Fossum, Kristian J Fougner, Synnøve E Holte, Kari Lima, Ragnar B Moe, Anne Grethe Myhre, E Helen Kemp, Bjørn G Nedrebø, Johan Svartberg, Eystein S Husebye

Abstract

Objective: The epidemiology of hypoparathyroidism (HP) is largely unknown. We aimed to determine prevalence, etiologies, health related quality of life (HRQOL) and treatment pattern of HP.

Methods: Patients with HP and 22q11 deletion syndrome (DiGeorge syndrome) were identified in electronic hospital registries. All identified patients were invited to participate in a survey. Among patients who responded, HRQOL was determined by Short Form 36 and Hospital Anxiety and Depression scale. Autoantibodies were measured and candidate genes (CaSR, AIRE, GATA3, and 22q11-deletion) were sequenced for classification of etiology.

Results: We identified 522 patients (511 alive) and estimated overall prevalence at 102 per million divided among postsurgical HP (64 per million), nonsurgical HP (30 per million), and pseudo-HP (8 per million). Nonsurgical HP comprised autosomal dominant hypocalcemia (21%), autoimmune polyendocrine syndrome type 1 (17%), DiGeorge/22q11 deletion syndrome (15%), idiopathic HP (44%), and others (4%). Among the 283 respondents (median age, 53 years [range, 9-89], 75% females), seven formerly classified as idiopathic were reclassified after genetic and immunological analyses, whereas 26 (37% of nonsurgical HP) remained idiopathic. Most were treated with vitamin D (94%) and calcium (70%), and 10 received PTH. HP patients scored significantly worse than the normative population on Short Form 36 and Hospital Anxiety and Depression scale; patients with postsurgical scored worse than those with nonsurgical HP and pseudo-HP, especially on physical health.

Conclusions: We found higher prevalence of nonsurgical HP in Norway than reported elsewhere. Genetic testing and autoimmunity screening of idiopathic HP identified a specific cause in 21%. Further research is necessary to unravel the causes of idiopathic HP and to improve the reduced HRQOL reported by HP patients.

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