Pilares para el enfoque y tratamiento adecuado del paciente con hipoparatiroidismo

  • Alejandro Roman-Gonzalez Universidad de Antioquia. Hospital Universitario San Vicente Fundación, Medellín.
  • Julia Zea-Lopera Universidad de Antioquia, Medellín.
  • Sergio Alberto Londoño-Tabares Universidad de Antioquia, Medellín.
  • Carlos Alfonso Builes-Barrera Universidad de Antioquia. Hospital Universitario San Vicente Fundación, Medellín.
  • Álvaro Sanabria Universidad de Antioquia, Clínica Vida, Medellín.
Palabras clave: Calcio, Fósforo, Hipocalcemia, Hipoparatiroidismo, Paratiroides

Resumen

El hipoparatiroidismo es definido como hipocalcemia en presencia de hormona paratiroidea baja (< 20 pg/mL) o indetectable. Es una enfermedad rara con una prevalencia estimada de 37 casos por 100.000 habitantes. Aunque la etiología es variada, la causa más frecuente, en 75 % de los casos, es el hipoparatiroidismo posoperatorio. Esta situación puede ocurrir en cualquier cirugía de cuello, pero es más frecuente en la resección de tiroides. Otras causas infrecuentes incluyen trastornos autoinmunes como el síndrome poliglandular tipo 1, desórdenes genéticos como la anomalía de DiGeorge o trastornos funcionales como la hipomagnesemia. Los síntomas agudos más importantes de la hipocalcemia son la irritación neuromuscular, como parestesias y convulsiones. Crónicamente se pueden presentar calcificaciones en varios sitios del cuerpo incluyendo los ganglios basales. El diagnóstico y enfoque de esta enfermedad parte de un valor disminuido de calcio combinado con PTH menor de 20 pg/mL, siempre excluyéndose hipomagnesemia. Además, debe solicitarse fósforo y calciuria de 24 horas. El tratamiento se realiza con reposición oral de calcio y vitamina D activa (calcitriol). En algunos casos con hipercalciuria se pueden usar diuréticos tipo tiazida. Recientemente se aprobó en Estados Unidos y Europa, el uso de hormona recombinante paratiroidea 1-84 en pacientes con hipoparatiroidismo que no estén controlados fácilmente con calcio y calcitriol o en aquellos que tengan complicaciones o deterioro en la calidad de vida.

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Biografía del autor/a

Alejandro Roman-Gonzalez, Universidad de Antioquia. Hospital Universitario San Vicente Fundación, Medellín.
Profesor, Departamento de Medicina Interna. Internista Endocrinólogo, Hospital Universitario San Vicente Fundación. 
Julia Zea-Lopera, Universidad de Antioquia, Medellín.
Residente de Medicina Interna.
Sergio Alberto Londoño-Tabares, Universidad de Antioquia, Medellín.
Residente de Medicina Interna.
Carlos Alfonso Builes-Barrera, Universidad de Antioquia. Hospital Universitario San Vicente Fundación, Medellín.
Profesor, Departamento de Medicina Interna. Internista Endocrinólogo.
Álvaro Sanabria, Universidad de Antioquia, Clínica Vida, Medellín.
Profesor Asociado. Departamento de Cirugía.

Citas

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Publicado
2018-04-05
Sección
Artículos de revisión