Hypoparathyroidsim

Question 1

What is hypoparathyroidism?

Answer 1

Disorder caused by deficiency of PTH synthesis and secretion, leading to low serum calcium and elevated serum phosphate

Question 2

What causes hypoparathyroidisim?

Answer 2

1. postoperative (thyroidectomy or parathyroidectomy)
2. autoimmune
3. nonautoimmune (wilson disease, haemochromatosis)
4. congenital (DiGeorge syndrome)

Question 3

What is meant by “Pseudo hypoparathyroidism”?

Answer 3

Rare genetic condition resulting in failure of target organs to respond to normal levels of parathyroid hormone. Causes short stature and fingers, symptoms of hypocalcaemia and vitamin D deficiency.

Question 4

What are the presenting symptoms/ signs of hypoparathyroidsim?

Answer 4

1. Hypocalcaemia = increased neuromuscular excitability = CATs go Numb → Convulsions, Arrhythmias, Tetany, Paraesthesia
   - Arrhythmias → prolonged QT interval
   - Tetany → muscle twitching, cramping and spasm
   - Paraesthesia, Numbness, Tingling
2. Poor Memory, Slowed Thinking
3. Malnutrition, Malabsorption, Diarrhoea
4. Chvostek’s Sign (ch = cheek) → contraction of facial muscles when facial nerve is tapped in front of the ear
5. Trousseau Sign (t = tighten cuff) → painful clasping response of fingers and hands when blood pressure cuff is inflated above systolic blood pressure

Question 5

What investigations are used to diagnose/ monitor hypoparathyroidsim?

Answer 5

1. Low PTH
2. Serum Calcium → low (and normal ALP)
3. Serum Phosphate → high
4. ECG → isolated prolonged QT interval (predisposes to TDP) indicates severe life-threatening hypocalcaemia
5. Serum Albumin → normal (low albumin will give a falsely low serum calcium)

Question 6

How is hypoparathyroidism managed?

Answer 6

• IV or Oral Calcium
• Plus Low dose calcitriol (form of Vit D)