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LETTER TO EDITOR
Year : 2012  |  Volume : 7  |  Issue : 1  |  Page : 45-46

Hypoparathyrodism


Department of Radiodiagnosis, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

Date of Web Publication4-May-2012

Correspondence Address:
Paramdeep Singh
Department of Radiodiagnosis, Dayanand Medical College and Hospital, Ludhiana, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1793-5482.95702

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How to cite this article:
Singh P, Saggar K, Sandhu P. Hypoparathyrodism. Asian J Neurosurg 2012;7:45-6

How to cite this URL:
Singh P, Saggar K, Sandhu P. Hypoparathyrodism. Asian J Neurosurg [serial online] 2012 [cited 2021 Dec 4];7:45-6. Available from: https://www.asianjns.org/text.asp?2012/7/1/45/95702

Sir,

A 20-year-old female presented with seizures, spasmodic contractions and paresthesia of limbs of the left side and ataxic gait of 3 years duration. Carpopedal spasm was present. Trousseau's and Chovstek's signs were positive. Cerebellar signs were positive. Biochemical analysis revealed hypocalcemia (1.3 mmol/L; normal range 2.10-2.60 mmol/L), hyperphosphatemia (2.5 mmol/L; normal range 0.8-1.5 mmol/L) and low Parathyroid hormone level (0.6 pmol/L; normal range 1.5-7.6 pmol/L). Imaging [Figure 1] revealed intracranial calcification. Hypocalcemia results in increased neuromuscular excitability, which manifests as tetany, paresthesia, seizures, organic brain syndrome or calcium deposition leading to cataract or intracranial calcification. Supplementation with calcium and 1,25-dihydroxy vitamin D is helpful in preventing seizures and progression to extrapyramidal disorders. [1],[2]
Figure 1: (a) Axial T 1 weighted magnetic resonance image showing symmetrical hyperintensities in the bilateral basal ganglia. (b) Computed tomography (CT) image of the same patient showing evidence of calcification in the basal ganglia. (c) Axial T1 weighted image showing symmetric hyperintense signal in bilateral dentate nuclei, which also showed evidence of calcification in CT sections

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Idiopathic hypoparathyroidism is an infrequent condition of unknown etiology. Accepted criteria for its diagnosis are (a) low serum calcium, (b) high serum inorganic phosphates and (c) exclusion of renal insufficiency, steatorrhea, chronic diarrhea, alkalosis and rickets and osteomalacia. The classic findings in a patient with hypoparathyroidism are a rounded expressionless face, a shorter height than average and cataract. Dental hypoplasia and aplasia develop depending upon the age at the time of onset of the disease. In idiopathic hypoparathyroidism, basal ganglia calcification and extrapyramidal syndromes are more frequently seen, and symptoms are earlier in onset. In pseudohypoparathyroidism, there is ineffective parathormone action rather than a failure of parathyroid hormone production. However, it shares several clinical features with hypoparathyroidism. [3]

Hypocalcemia increases the neuromuscular excitability, which may result in tetany. Lower degrees of neuromuscular excitability may lead to latent tetany, which can be elicited by Chovstek's and Trousseau's signs. Chovstek's sign is demonstrated by tapping the skin over the facial nerve anterior to the external auditory meatus, and results in ipsilateral contraction of the facial muscles. Trousseau's sign is produced by inflating a sphygmomanometer to 20 mmHg above the systolic blood pressure for 3-5 min, which results in ischemia of nerves in the upper arm leading to thumb adduction, metacarpophalangeal joint flexion and interphalangeal joint extension. [1],[2]

 
  References Top

1.Sztriha L, Punnose J, Prais V, El-Khider A, Chandran P, Al Suhaili AR. Idiopathic hypoparathyroidism with basal ganglia calcification, epilepsy and interictal hyperperfusion. J Child Neurol 1998;13:189-92.  Back to cited text no. 1
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2.Abe S, Tojo K, Ichida K, Shigematsu T, Hasegawa T, Morita M, et al. A rare case of idiopathic hypoparathyroidism with varied neurological manifestations. Intern Med 1996;35:129-34.  Back to cited text no. 2
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3.Potts TJ. Diseases of the parathyroid gland and other hyper and hypocalcemic disorder. In: Harrison's principles of internal medicine, 14 th ed. New York: McGraw Hill; 1998;2:2241-3.  Back to cited text no. 3
    


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