Subjective Health Status, Life Performance and Complications in Chronic Hypoparathyroidism – a German Multicenter Survey

Carmina Teresa Fuss^1*Sarah Engbers¹Nicole Reisch²Anke Hannemann^3,4Henry Völzke^4,5Hans J Grabe^6,7Matthias Gauck^3,4Michael Droste⁸Holger S. Willenberg⁹Nada Rayes¹⁰Martin Fassnacht¹¹Marcus Quinkler¹²Stefanie Hahner¹

• ¹Division of Endocrinology and Diabetology, Department of Internal Medicine I, University Hospital of Wuerzburg, Würzburg, Germany
• ²Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
• ³Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
• ⁴DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
• ⁵Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
• ⁶Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
• ⁷German Centre for Neurodegenerative Diseases (DZNE), Partner Site Rostock/Greifswald, Greifswald, Germany
• ⁸Practice for Endocrinology and Diabetes, Oldenburg, Germany
• ⁹Division of Endocrinology and Metabolism, Rostock University Medical Center, Rostock, Germany
• ¹⁰Department of General, Visceral, and Transplant Surgery, University Hospital Leipzig, Leipzig, Germany
• ¹¹Department of Internal Medicine, Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, Würzburg, Germany
• ¹²Endokrinologie in Charlottenburg, Endokrinologie Praxis am Stuttgarter Platz, Berlin, Germany

Background: There is mounting evidence that conventional replacement strategies with calcium and vitamin D are insufficient to fully prevent complications of chronic hypoparathyroidism (HypoPT) in all patients. Methods: To investigate the disease burden of chronic HypoPT, we performed a survey in 205 HypoPT patients (159 females; median age 55 years; median disease duration 16 years). Patients received a disease-specific questionnaire asking for subjective health status, comorbidities, disease-related emergencies and interference of HypoPT with daily and work life. Patients were further assessed by the SF-36 questionnaire. Data was compared to sex-and age-matched subjects from the Study of Health in Pomerania SHIP-START, the German Health Interview and Examination Survey for Adults (DEGS1) and to 214 patients with adrenal insufficiency. Results: Clinical symptoms associated with HypoPT during the past 12 months were reported by 92% of patients, requiring medical intervention in 32%. Since primary diagnosis of HypoPT, 36% of patients had presented at least once at an emergency department due to severe hypocalcemia (14.7 events per 100 patient years). Trigger factors for hypocalcemic symptoms were reported by 76% of patients (e.g. physical activity, infections, hot weather). In comparison to population-based controls, patients with HypoPT showed a higher prevalence of renal insufficiency (11% vs. 2%, p<0.001) and more frequently received antihypertensive (44% vs. 34%; p=0.003) and antiepileptic drugs (5% vs. 2%, p=0.01). Lifetime prevalence of both depression (22% vs. 15%, p=0.003) and anxiety (21% vs. 6%, p<0.001) were increased in HypoPT. SF-36 values indicated significantly reduced subjective health status in HypoPT patients compared to controls as well as patients with adrenal insufficiency.