hypoparathyroidism

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=110 BGCOLOR="#666699" TEXT="#080000" bgproperties="fixed" background="04a00840erlcjm.png"> <div> <FONT SIZE="5" COLOR="#FFFFFF" FACE="Arial" ><B>usmle medecine part 2</B></FONT><B>     |     </B><A HREF="index.htm" TARGET="_top" TITLE="usmle medecine part 2"><U><B>home</B></U></A></div> <div> <A HREF="id18.htm" TARGET="_top" TITLE="crest syndrome"><U>crest syndrome</U></A>   |   <A HREF="id20.htm" TARGET="_top" TITLE="raynauld phenomenon"><U>raynauld phenomenon</U></A>   |   <A HREF="id19.htm" TARGET="_top" TITLE="scleroderma"><U>scleroderma</U></A>   |   <A HREF="id22.htm" TARGET="_top" TITLE="The Iliac Crest Syndrome"><U>The Iliac Crest Syndrome</U></A>   |   <A HREF="id23.htm" TARGET="_top" TITLE="cardio"><U>cardio</U></A>   |   <B>hypoparathyroidism</B>   |   <A HREF="id25.htm" TARGET="_top" TITLE="hypercalcemia"><U>hypercalcemia</U></A>   |   <A HREF="id26.htm" TARGET="_top" TITLE="hyperphosphatemia"><U>hyperphosphatemia</U></A>   |   <A HREF="id27.htm" TARGET="_top" TITLE="leukemia"><U>leukemia</U></A>   |   <A HREF="id21.htm" TARGET="_top" TITLE="glossary"><U>glossary</U></A>   |   <A HREF="id17.htm" TARGET="_top" TITLE="Contact Me"><U>Contact Me</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" width=190 BGCOLOR="#CCCCFF" TEXT="#080000" background="04411c00egdysm.png"> <div> <A HREF="id18.htm" TARGET="_top" TITLE="crest syndrome"><U><B>crest syndrome</B></U></A></div> <div> <A HREF="id20.htm" TARGET="_top" TITLE="raynauld phenomenon"><U><B>raynauld phenomenon</B></U></A></div> <div> <A HREF="id19.htm" TARGET="_top" TITLE="scleroderma"><U><B>scleroderma</B></U></A></div> <div> <A HREF="id22.htm" TARGET="_top" TITLE="The Iliac Crest Syndrome"><U><B>The Iliac Crest Syndrome</B></U></A></div> <div> <A HREF="id23.htm" TARGET="_top" TITLE="cardio"><U><B>cardio</B></U></A></div> <div> <B>hypoparathyroidism</B></div> <div> <A HREF="id25.htm" TARGET="_top" TITLE="hypercalcemia"><U><B>hypercalcemia</B></U></A></div> <div> <A HREF="id26.htm" TARGET="_top" TITLE="hyperphosphatemia"><U><B>hyperphosphatemia</B></U></A></div> <div> <A HREF="id27.htm" TARGET="_top" TITLE="leukemia"><U><B>leukemia</B></U></A></div> <div> <A HREF="id21.htm" TARGET="_top" TITLE="glossary"><U><B>glossary</B></U></A></div> <div> <A HREF="id17.htm" TARGET="_top" TITLE="Contact Me"><U><B>Contact Me</B></U></A></div> <div> <B>  <a href="http://counter.mycomputer.com/"><img alt="Counter" src="http://counter.mycomputer.com/c.count?u=dhammoud&c=1" border=0></a>   </B></div> <div> <B><IMG SRC="074c6a30.png" border=0 width="198" height="163" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> </td> <td valign="top" height=370 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> hypoparathyroidism</div> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B><U>Three Categories of </U></B><FONT SIZE="3" COLOR="#800000" FACE="Arial" ><B><U>Hypoparathyroidism</U></B></FONT><B><U> (each discussed below)</U></B></div> <div> <B>[1]</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" ><B> Deficient Parathyroid Hormone Secretion.</B></FONT></div> <div> <B>[2]</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" ><B> Inability to make an active form of PTH.</B></FONT></div> <div> <B>[3]</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" ><B> Inability of the kidneys & bones to respond to PTH.</B></FONT></div> <bR> <bR> <div> Hypoparathyroidism is most commonly caused by a total thyroidectomy.</div> <div>  Because parathormone (PTH) normally increases calcium reabsorption in the kidney and decreases the reabsorption of phosphate, patients develop </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">hypocalcemia, </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">hyperphosphatemia,</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> and decreased PTH.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> Hypocalcemia results in clinical evidence of tetany, such as carpal spasm after pumping up a blood pressure cuff (Trousseau's sign) and facial muscle contractions after tapping on the facial nerve (Chvostek's sign). </div> <bR> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Hypercalcemia, hypophosphatemia, and increased PTH  are present in <FONT SIZE="3" COLOR="#FF0000" FACE="Arial" ><B>primary hyperparathyroidism</B></FONT>, </div> <div> which is most commonly (85%) due to a benign parathyroid adenoma. It is the most common cause of hypercalcemia in the ambulatory population.</div> <bR> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Hypercalcemia, hypophosphatemia, and decreased PTH  are characteristic of <FONT SIZE="3" COLOR="#FF0000" FACE="Arial" ><B><U>malignancy-induced hypercalcemia.</U></B></FONT> </div> <div> This condition is most commonly due to secretion of a PTH-like peptide that acts on the kidney. </div> <div> The result is increased calcium reabsorption (hypercalcemia) and decreased phosphorus reabsorption (hypophosphatemia), but the hypercalcemia suppresses the patient's own PTH production. </div> <div> Other mechanisms for hypercalcemia in malignancy relate to the secretion of osteoclast-activating factor or prostaglandins.</div> <bR> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Hypocalcemia, hypophosphatemia, and increased PTH  are seen in<FONT SIZE="3" COLOR="#FF0000" FACE="Arial" ><B><U> malabsorption of vitamin D due to celiac disease or other gastrointestinal (GI) </U></B></FONT>diseases. </div> <div> Vitamin D normally increases the reabsorption of both calcium and phosphorus from the gut. </div> <div> Therefore, deficiency results in hypocalcemia and hypophosphatemia, the former serving as a potent stimulus for PTH synthesis and secondary hyperparathyroidism.</div> <bR> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Hypocalcemia, hyperphosphatemia, and increased PTH are seen in<FONT SIZE="3" COLOR="#FF0000" FACE="Arial" ><B><U> renal failure</U></B></FONT>. </div> <div> Because PTH normally increases the synthesis of the hydroxylating enzyme located in the renal tubules and is responsible for the second hydroxylation step of vitamin D, renal disease results in hypovitaminosis D, with a subsequent hypocalcemia and secondary hyperparathyroidism. </div> <div> The kidney is also the excretion route for phosphate; therefore, renal failure results in retention of phosphate.</div> <div>  This constellation of findings is also seen in pseudohypoparathyroidism, which is a genetic disease that is associated with a resistance of the target tissue to PTH.</div> <div>  Therefore, hypocalcemia and hyperphosphatemia are present; but, unlike primary hypoparathyroidism, the PTH is usually increased.</div> <bR> <bR> <bR> <div> <B> Serum Calcium     Serum Phosphorus        Serum Parathormone (PTH)            Causes </B></div> <div> <B> </B><FONT SIZE="3" COLOR="#FF0000" FACE="Arial" ><B>Increased               Decreased                         Increased                                              primary hyperparathyroidism</B></FONT></div> <div> <B> </B><FONT SIZE="3" COLOR="#003366" FACE="Arial" ><B>Increased               Decreased                         Decreased                                            malignant induced hypercalcemia </B></FONT></div> <div> <B> Decreased             Increased                           Decreased                                            total thyroidectomy </B></div> <div> <B> </B><FONT SIZE="3" COLOR="#CC0099" FACE="Arial" ><B>Decreased             Decreased                         Increased                                              malabsorption of vit d</B></FONT></div> <div> <B> Decreased             Increased                           Increased                                              renal failure</B></div> <div> <B> </B></div> <div> - most common cause of <FONT SIZE="3" COLOR="#800000" FACE="Arial" >hypoparathyroidism</FONT> is inadvertant damage or removal of the parathyroids during surgical removal of the thyroid;</div> <div>  - in idiopathic cases, look for ectodermal changes, mental retardation, monilial infections, low Ca; </div> <div> - congenital hypoparathyroid & late onset <FONT SIZE="3" COLOR="#800000" FACE="Arial" >hypoparathyroidism</FONT> from other causes in adulthood are rare conditions; </div> <div> - <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>pseudo</U></FONT><FONT SIZE="3" COLOR="#800000" FACE="Arial" ><U>hypoparathyroidism</U></FONT> is another cause of this disorder;</div> <div>  - end organ unresponsiveness to parathyroid hormone;</div> <div>  - patients tend to be short and may have short metacarpals (index, ring, little); </div> <div> <B>Deficient Parathyroid Hormone Secretion.</B></div> <div> This type of <FONT SIZE="3" COLOR="#800000" FACE="Arial" >hypoparathyroidism</FONT> is the easiest to understand. A patient afflicted with this condition simply has too little (or a complete absence of) parathyroid tissue therefore, inadequate PTH is produced. <FONT SIZE="3" COLOR="#800080" FACE="Arial" >There are two major causes of this problem:</FONT></div> <div> <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><B>A)</B></FONT><B> </B><FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><B>Post Surgical.</B></FONT> The first (and most common) mechanism by which inadequate parathyroid hormone is produced is due to the removal of parathyroid glands at the time of surgery. The operations which are typically associated with this problem are <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>operations designed to remove parathyroid glands for hyperparathyroidism</U></FONT>. The goal of this operation is to remove those parathyroid glands which are overproducing PTH, however, occasionally, (less than 1%) too much parathyroid tissue is removed. The second operation which is associated with postoperative <FONT SIZE="3" COLOR="#800000" FACE="Arial" >hypoparathyroidism</FONT> is <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>total thyroidectomy.</U></FONT> This operation is performed for a number of reasons, but because of the close relationship that the thyroid and parathyroid have to one another (including sharing the same blood supply) the parathryoid glands can be injured or removed. This is very rare and occurs in much less than 1% of thyroid operations. In many patients, the inadequate secretion of PTH is transient following surgery on the thyroid or parathyroid glands, so this diagnosis cannot be made immediately following surgery.</div> <div> <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><B>B) Idiopathic.</B></FONT> Deficient PTH secretion without a defined cause (e.g. surgical injury) is termed Idiopathic <FONT SIZE="3" COLOR="#800000" FACE="Arial" >hypoparathyroidism</FONT>. This disease is rare and can be <FONT SIZE="3" COLOR="#800080" FACE="Arial" ><B>congenital</B></FONT> or <FONT SIZE="3" COLOR="#800080" FACE="Arial" ><B>acquired</B></FONT> later in life.</div> <div> <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><B>Congenital.</B></FONT> Patients in this category are born without parathyroid tissues. Most patients with congenital <FONT SIZE="3" COLOR="#800000" FACE="Arial" >hypoparathyroidism</FONT> have no family history of the disease. Those who do may have any one of a number of congenital causes. The pattern of inheritance is as varied as the kinds of genetic abnormalities that cause the disease. The children in some families are at a 50% risk for disease (dominant gene defect) while others are at a risk of 25% or less (recessive gene defect). In some families only the boys suffer from disease. This sex-linked inheritance pattern indicates the presence of a genetic defect on the X chromosome. The inherited forms tend to arise from abnormal genes that either: 1) encode abnormal forms of PTH or its receptor, 2) prevent normal conduction of cell signals from the PTH receptor to the nucleus, or 3) prevent normal gland development before birth.</div> <div> <FONT SIZE="3" COLOR="#800000" FACE="Arial" >Hypoparathyroidism</FONT> with onset during the first few months of life can be permanent or temporary. The cause is usually unknown and if spontaneous resolution occurs. If it does not, it will usually become manifest by 24 months of age. Finally, mothers who have overactive parathyroid glands may have high calcium levels. The excess ionized calcium can enter the baby and suppress the baby’s parathyroid gland function. If suppression of the gland is not released quickly enough after birth, low calcium levels can be a temporary problem for the baby. This will <B>not</B> result in permanent parathyroid gland dysfunction in the child.</div> <div> <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><B>Acquired.</B></FONT> The acquired form of this disease typically arises because the immune system has developed antibodies against parathyroid tissues in an attempt to reject what is sees as a foreign tissue, much as it would a transplanted organ. This disease can affect the parathyroid glands in isolation or can be part of a syndrome that involves many organs. An antibody that binds to the calcium sensor in the parathyroid gland has been discovered in the blood of patients with autoimmune <FONT SIZE="3" COLOR="#800000" FACE="Arial" >hypoparathyroidism</FONT>. It has been proposed that such binding "tricks" the parathyroid gland into believing that the blood level of ionized calcium is high. Responding to this signal, the parathyroid stops making PTH.</div> <div> <B>C)</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" ><B> </B></FONT><B>Hypomagnesemia</B>.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > The element magnesium is closely related to the action of calcium in the body. When magnesium levels are too low, calcium levels may also fall. It appears that magnesium is important for parathyroid cells to make PTH normally. Once recognized, this is usually very easy to fix. Chronic alcoholism is a frequent cause of low calcium and magnesium levels.</FONT></div> <bR> <bR> <div> <B>[2]</B><FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><B> Secretion of Biologically Inactive Parathyroid Hormone.</B></FONT></div> <div> This section is placed here for completion sake only. There have only been a few cases of this syndrome ever reported, but one can see that if the PTH which is produced is actually a defective hormone, it would not have the same biologic strength as its normal counterpart.</div> <bR> <bR> <div> <FONT SIZE="3" COLOR="#FF0000" FACE="Arial" ><B>[3]</B></FONT><B> Resistance to Parathyroid Hormone (pseudo-</B><FONT SIZE="3" COLOR="#800000" FACE="Arial" ><B>hypoparathyroidism</B></FONT><B>)see below.</B></div> <div> This disease is also VERY RARE! Like all patients with <FONT SIZE="3" COLOR="#800000" FACE="Arial" >hypoparathyroidism</FONT>, this disease is characterized by hypocalcemia (too low calcium levels), hyperphosphatemia (too high phosphorus levels), but they are distinguished by the fact that they produce PTH but their bones and kidneys do not respond to it. Even if PTH is given to them in their veins, they do not respond to it. Therefore, these rare individuals have plenty of PTH, but their organs do not behave appropriately to it (so they look to be hypoparathyroid but they are not...thus the name "pseudo-hypoparathyroid").</div> <bR> <div> <B>- Laboratory Findings:</B> </div> <div> - decreased plasma calcium; </div> <div>  - in the disorder of pseudopseudo<FONT SIZE="3" COLOR="#800000" FACE="Arial" >hypoparathyroidism</FONT>, all of the clinical features of pseudoparathyroidism are present, but the serum calcium is normal; - increase in plasma phosphate;</div> <div> - increase in renal tubualar reabsorption of phosphate - decrease in the number of bone remodeling centers;</div> <bR> <div>  <B>- Radiographs:</B> </div> <div> - eventhough in <FONT SIZE="3" COLOR="#800000" FACE="Arial" >hypoparathyroidism</FONT> there are fewer "bites" taken out of bone by the remodeling centers, this causes very few abnormalities in bones in adults;</div> <div>  - majority of these patients are treated w/ relatively high doses of Vit D to maintain their plasma Ca levels, which can, in itself, stimulate the bone remodely system; </div> <div> - subcutaneous calcifications may be present in <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>pseudo</U></FONT><FONT SIZE="3" COLOR="#800000" FACE="Arial" ><U>hypoparathyroidism</U></FONT>, where as basal ganglia calcifications are seen in idiopathic <FONT SIZE="3" COLOR="#800000" FACE="Arial" >hypoparathyroidism</FONT>;</div> <bR> <div>  <B>- Treatment:</B> </div> <div> - <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>Ca supplements</U></FONT> are generally used and it is important to add to diet at least 1 gm/day elemental calcium; - milk and cheese products (that are high in phospate content) should be avoided; </div> <bR> <bR> <bR> <div> <B><U>hypoparathyroidism</U></B></div> <bR> <div> etiology: </div> <div> <U><IMG BORDER="0" SRC="Symb075c00b700f0ff000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">idiopathic</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">secondary: surgery, I-131 therapy (rare), radiation, hemmorhage, infection, <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>thyroid Ca</U></FONT>, <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>hemochromatosis</U></FONT> </div> <div> physical findings: </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">tetany </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">hypocalcemia + hyperphosphatemia </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">normal/low alkaline phosphatase </div> <div> xray findings: </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">premature closing of epiphyses </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">generalized increased bone density in 9% </div> <div> <U><IMG BORDER="0" SRC="Symb075c00b700f0ff000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">localized thickening of the skull</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">sacroiliac, femoral head, acetabulum </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">band like density in metaphyses of long bones (25%) </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">thickened lamina dura and widened diploe </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">soft tissue abnormalities </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">intracranial calcifications (<FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>basal ganglia</U></FONT>, choroid plexus) </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">calcification of spinal and other ligaments </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">subcutaneous calcifications; ectopic bone formation </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">ossification of muscle insertions </div> <div> <B> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" WIDTH="893" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 1048 WIDTH="881"><div> <B>History: </B>Symptoms occur when ionized calcium drops to less than 2.5-3 mg/100 mL. The symptoms are mainly neurologic, secondary to the hyperexcitability of neuronal membranes that develops in a low-calcium environment. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Cardiac effects are limited because cardiac tetany occurs at levels of hypocalcemia lower than those causing neurological effects; therefore, the patient usually comes to medical attention prior to the onset of cardiac disturbances. At presentation, electrocardiogram (ECG) changes may be noted, but generally the heart is functioning normally.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Neurologic effects in adults</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Extremity and periorbital paresthesias</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Muscle cramping and spasms</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Altered mental status</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Psychosis</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Pain</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Difficulty walking</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Neurologic effects in infants</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Hyperirritability</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Muscle rigidity with normal mental status</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Seizures</div> <div> <B>Physical: </B>The clinical manifestation of <FONT SIZE="3" COLOR="#800000" FACE="Arial" >hypoparathyroidism</FONT> is hypocalcemia. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Neurologic effects</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Hyperreflexia (Positive Chvostek or Trousseau sign is a classic sign of hypocalcemia.)</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Tetany</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Seizures</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Altered level of consciousness</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Cardiovascular - Decreased contractility that can result in heart failure</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Infants</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Vomiting</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Abdominal distention</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Apneic spells</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Intermittent cyanosis</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Twitching, tremors, and seizures</div> <div> <B>Causes: </B><FONT SIZE="3" COLOR="#800000" FACE="Arial" >Hypoparathyroidism</FONT> has multiple etiologies. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Congenital</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Parathyroid aplasia</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">DiGeorge syndrome (dysgenesis of thymus and parathyroid glands)</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Iatrogenic</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Surgery is the most common cause of <FONT SIZE="3" COLOR="#800000" FACE="Arial" >hypoparathyroidism</FONT>.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000008000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Hypoparathyroidism<FONT SIZE="3" COLOR="#000000" FACE="Arial" > can occur after surgical resection of parathyroid adenoma. (This phenomenon often is transient, secondary to suppression of other parathyroid glands.)</FONT></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Total parathyroidectomy or thyroidectomy can lead to <FONT SIZE="3" COLOR="#800000" FACE="Arial" >hypoparathyroidism</FONT> because of parathyroid gland removal or destruction of the parathyroid vascular supply.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Infiltration or destruction</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Sarcoidosis</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Wilson disease</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Hemachromatosis</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Metastatic carcinoma</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Infarction</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Radiation</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Suppression of the parathyroid gland</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Hypomagnesemia - May be caused by pancreatitis, aminoglycosides, pentamidine, loop diuretics, cisplatin, and amphotericin B</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Hypermagnesemia</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Drugs - eg, aluminum, asparagine, doxorubicin, cytosine, arabinoside, cimetidine</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Idiopathic - likely an autoimmune disorder; can occur in conjunction with other endocrine anomalies</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Early onset - autoimmune polyglandular syndrome type 1 </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Late onset - Kenny syndrome </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000008000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Hypoparathyroidism<FONT SIZE="3" COLOR="#000000" FACE="Arial" > also can be sporadic.</FONT></div> <bR> </tD> </tR> </TABLE></B></div> <div> <B><U>idiopathic </U></B><FONT SIZE="4" COLOR="#800000" FACE="Arial" ><B><U>hypoparathyroidism</U></B></FONT></div> <bR> <div> rare condition of unknown cause </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">round face; short dwarf-like; obese </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">mental retardation </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">cataracts </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">dry scaly skin; atrophy of nails </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">dental hypoplasia (delayed tooth eruption, impaction of teeth, supernumerary teeth) </div> <bR> <bR> <bR> <div> <B><U> </U></B><B><U> <A NAME="311"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></U></B><B><U>Pseudo</U></B><FONT SIZE="4" COLOR="#800000" FACE="Arial" ><B><U>hypoparathyroidism</U></B></FONT><B><U>:</U></B></div> <div> - lack of responsiveness to <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>PTH</U></FONT> due to defect in adenyl cyclase; </div> <div> - clinical picture may resemble of <FONT SIZE="3" COLOR="#800000" FACE="Arial" ><U>hypoparathyroidism;</U></FONT></div> <div>  - due to inability of bone & kidney to respond to parathyroid hormone, <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>hypocalcemia</U></FONT> and <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>hyperphosphatemia</U></FONT> occur in spite of elevated parathyroid levels;</div> <div>  - pts w/ this disorder have a characteristic clinical appearance that includes short stature, round facies, & shortened 4th metacarpals; </div> <div> - subQ <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>calcifications</U></FONT> that may be present in pseudo<FONT SIZE="3" COLOR="#800000" FACE="Arial" >hypoparathyroidism</FONT> not present in the idiopathic disorder; </div> <bR> <bR> <bR> </td> </tr></table></body>