Hypoparathyroidism (B)

Question 1

How does hypoparathyroidism present?

Answer 1

Hypoparathyroidism has wide variety of presentations: from the asymptomatic patient with dramatically low serum calcium to the acutely symptomatic patient with neuromuscular irritability, tetany, painful muscle cramps, stridor, and even seizures with low serum calcium in the accident and emergency department or recovery room.

Question 2

how do most cases present?

Answer 2

Majority of cases are post-surgery for benign and malignant thyroid disorders, hyperparathyroidism, and laryngeal or other head and neck cancers.

Question 3

What are non-surgical causes of hypoparathyroidism?

Answer 3

Nonsurgical aetiologies include: rare genetic conditions and syndromes; autoimmune destruction of the glands; destruction or invasion due to tumour, radiation, or infiltration by iron or copper; hypomagnesaemia and magnesium depletion; and idiopathic.

Question 4

What are labratory findings?

Answer 4

Laboratory testing should confirm low ionised or albumin-corrected total calcium and low or inappropriately normal intact plasma parathyroid hormone (PTH), while also verifying normal serum magnesium and 25-hydroxyvitamin D levels.

Question 5

What are key diagnostic features?

Answer 5

history of thyroid, parathyroid or laryngeal surgery
chronic alcoholism
malnutrition, malabsorption, diarrhoea
muscle twitches, spasms, cramps

lesser 
anxiety
dry hair, brittle nails
cataracts
history of mucocutaneous candidiasis

Question 6

What are risk factors?

Answer 6

thyroid surgery
parathyroid surgery
hypomagnesaemia
moderate and chronic maternal hypercalcaemia (neonatal hypocalcaemia)

Question 7

What investigations should be ordered?

Answer 7

serum calcium
serum albumin
ECG
plasma intact PTH