Hypoparathyroidism Natural History

Study Overview
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Brief Summary
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This is a prospective three year natural history study of adults with hypoparathyroidism. The goal is to monitor patients with hypoparathyroidism to define end-organ damage in the context of the disease. Funding Source- FDA OOPD

Detailed Description
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The goal of this study is to prospectively collect data on the natural history of hypoparathyroidism (HPT). This will enable longitudinal data collection of complications in this disease, specifically defining the epidemiology of end-organ complications of HPT that are related to high calcification propensity. It will also determine relationships between calcification burden and end-organ disease severity and progression risk and assess the utility of traditional and novel biomarkers of mineral and bone metabolism on disease diagnosis and monitoring. These data will inform future investigations on the development, study, and implementation of HPT end-organ disease modifying strategies and impact clinical practice in hypoparathyroidism.The study objectives are to: Build a prospective cohort of patients to study HPT-associated end-organ damage. Determine end-organ physiologic consequences of HPT. Elucidate determinants of HPT-associated end-organ damage.

Official Title
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Advancing Product Development for Hypoparathyroidism: A Prospective Natural History Study of the Clinical Outcomes and Regulation of Disordered Mineral Metabolism

Conditions
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Hypoparathyroidism

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: An understanding, ability and willingness to fully comply with study procedures and restrictions. Ability to voluntarily provide written, signed and dated informed consent as applicable to participate in the study. Male or female ≥18 years of age with HPT. All HPT sub-types are eligible, including surgical (HPT-S) and nonsurgical (HPT-NS) HPT: autoimmune, genetic (including but not limited to: DiGeorge syndrome, autoimmune polyendocrine syndrome type 1, hypoparathyroidism sensorineural deafness and renal disease syndrome, Kearns-Sayre syndrome, mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes [MELAS] syndrome, mitochondrial trifunctional protein [MTP] deficiency syndrome, Kenny-Caffey syndrome, Sanjad-Sakati syndrome, autosomal dominant hypocalcemia), infiltrative (granulomatous), mineral deposition (copper, iron), metastatic, radiation and idiopathic HPT. Diagnosis of HPT established based on historic hypocalcemia in the setting of inappropriately low serum PTH levels on two occasions. All treatment regimens are permitted, including but not limited to conventional management with calcium (e.g. calcium citrate, calcium carbonate, etc), active vitamin D (calcitriol, alfacalcidol), parent vitamin D, magnesium, phosphate binders and thiazides. Use of PTH-like drugs are permitted. Exclusion Criteria: Functional HPT Transient HPT Pseudohypoparathyroidism Pregnancy

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Kidney function | blood test for changes in eGFR (in mL/min/1.73m^2) | baseline, 6, 12, 18, 24, 30, 36 Months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Kidney calcification | Changes in kidney calcification and stones will be assessed by abdominal CT in an optional imaging sub group. Results will be assessed and reported by a clinician. | Baseline and 36 Months | 
| Brain calcification | Changes in brain calcification will be assessed by head CT in an optional imaging sub-group. Results will be assessed and reported by a clinician. | Baseline and 36 Months | 
| Vascular calcification | Changes in vascular calcification will be assessed by leg arterial calcifications on high resolution quantitative computed tomography in all, and aortic calcifications on abdominal CT and vertebral fracture assessment by DXA in optional imaging sub-group | Baseline and 36 Months | 
| Bone mineral density | Changes in dual energy X-ray absorptiometry will be assessed in an optional imaging sub-group | Baseline and 36 Months | 
| Bone microarchitecture and bone strength | Changes in high resolution peripheral quantitative computed tomography will be assessed | Baseline and 36 Months | 
| Cardiac function | Changes in EKG will be assessed | Baseline and 36 Months | 
| Transcriptomic signaling for calcification | Changes in microRNA will be assessed | Baseline and 36 Months | 
| Biomarkers blood | Changes in complete metabolic panel to see changes with eGFR (including albumin-corrected serum calcium), PTH, phosphorus, magnesium, 25(OH)D, 25(OH)D2, TSH, FT4. | baseline, 6, 12, 18, 24, 30, 36 Months | 
| Biomarkers urine | 24 hour urine will be collected for changes in calcium, creatinine, total volume and protein | baseline, 6, 12, 18, 24, 30, 36 Months | 
| Dietary Intake | Food frequency questionnaires will be administered to measure changes in calcium, phosphorus, vitamin D, and sodium intake | baseline, 12, 24 and 36 Months | 
| Cognitive Function | Changes in cognitive function will be assessed by NIH Toolbox®; Letter Fluency by the Controlled Oral Word Association Test with the letters FAS; Sematic Fluency by Animal Fluency; List Learning and Memory by the Hopkins Verbal Learning Test; subjective cognitive function by FACT-Cog | baseline, 12, 24 and 36 Months | 
| Neurologic Tests of Motor Function | Repeated Chair Stand (RCS) test will be administered to see how many times a patient can sit in and stand from a chair in 30 seconds and Timed Up and Go Test will measure how many seconds it takes for a patient to walk to assess changes in motor function | baseline, 12, 24 and 36 Months | 
| Quality of Life Through Self-Reported Questionnaires | Quality of life will be assessed by SF-36, FACIT-IF (self-reported fatigue), PGI-S and PGI-I (patient global impression of severity and impact), Hospital Anxiety and Depression Scale (HADS) and the HPT Symptom Diary and changes will be tracked through visits | baseline, 12, 24 and 36 Months | 
| Calcioprotein Maturation Time | Will be obtained through blood collection and measured in minutes and changes will be tracked through visits | Baseline and 36 months | 
| Sclerostin | Will be obtained through blood collection and measured in pmol/L and changes will be tracked through visits | Baseline and 36 months | 
| FGF23 | Will be obtained through blood collection and measured in pg/mL and changes will be tracked through visits | Baseline and 36 months |