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09-SEPTEMBER-2008 02:07:44 - Hypoparathyroidism Hypoparathyroidism Classification and external resources ICD-10 E20., E89.2, P71.4 ICD-9 252.1 DiseasesDB 6490 eMedicine med/1131 emerg/276 ped/1125 MeSH D007011 In medicine endocrinology, hypoparathyroidism is decreased function of the parathyroid glands, leading to decreased levels of parathyroid hormone PTH. The consequence, hypocalcemia, is a serious medical condition. Contents 1 Signs and symptoms 2 Diagnosis 3 Causes 4 Treatment 5 Possible Complications 6 References 7 See also Signs and symptoms Tingling lips, fingers, and toes Muscle cramps Pain in the face, legs, and feet Abdominal pain Dry hair Brittle nails Dry, scaly skin Cataracts Weakened tooth enamel in children Muscle spasms called tetany can lead to spasms of the larynx, causing breathing difficulties Convulsions seizures Additional symptoms that may be associated with this disease include: Painful menstruation Hand or foot spasms Decreased consciousness Delayed or absent tooth formation In contrast to hyperparathyroidism hyperfunction of the parathyroids, hypoparathyroidism does not have consequences for bone. Diagnosis Diagnosis is by measurement of calcium, serum albumin for correction and PTH in blood. PTH degrades rapidly at ambient temperatures and the blood sample therefore has to be transported to the laboratory on ice. If necessary, measuring cAMP cyclic AMP in the urine after an intravenous dose of PTH can help in the distinction between hypoparathyroidism and other causes. Differential diagnoses are: Pseudohypoparathyroidism normal PTH levels but tissue insensitivity to the hormone, associated with mental retardation and skeletal deformities and pseudopseudohypoparathyroidism sic. Vitamin D deficiency or herary insensitivity to this vitamin X-linked dominant. Malabsorption Kidney disease Medication: steroids, diuretics, some antiepileptics. Other tests include ECG for abnormal heart rhythms, and measurement of blood magnesium levels. Causes Hypoparathyroidism can have a number of divergent causes: Removal of the parathyroid glands in thyroid surgery thyroidectomy is a recognised cause. It is now uncommon, as surgeons generally spare them during the procedure after identifying them. Autoimmune invasion and destruction is the most common non-surgical cause. It can occur as part of autoimmune polyendocrine syndromes. Hemochromatosis can lead to iron accumulation and consequent dysfunction of a number of endocrine organs, including the parathyroids. Absence or dysfunction of the parathyroid glands is one of the components of chromosome 22q11 microdeletion syndrome other names: DiGeorge syndrome, Schprintzen syndrome, velocardiofacial syndrome. Magnesium deficiency DiGeorge syndrome, a childhood disease in which hypoparathyroidism occurs due to a total absence of the parathyroid glands at birth. Familial hypoparathyroidism occurs with other endocrine diseases, such as adrenal insufficiency, in a syndrome called type I polyglandular autoimmune syndrome PGA I. Some very rare diseases Idiopathic of unknown cause, occasionally familial Treatment Severe hypocalcemia, a potentially life-threatening condition, is treated as soon as possible with intravenous calcium e.g. as calcium gluconate. Generally, a central venous catheter is recommended, as the calcium can irritate peripheral veins and cause phlebitis. Long-term treatment of hypoparathyroidism is with calcium and Vitamin D3 supplementation D1 is ineffective in the absence of renal conversion. Teriparatide, a synthetic form of PTH presently registered for osteoporosis might become the treatment of choice for PTH supplementation, although further studies are awaited. In the event of a life-threatening attack of low calcium levels or tetany prolonged muscle contractions, calcium is administered by intravenous IV infusion. Precautions are taken to prevent seizures or larynx spasms. The heart is monitored for abnormal rhythms until the person is stable. When the life-threatening attack has been controlled, treatment continues with medicine taken by mouth. Possible Complications Tetany can lead to a blocked airway, requiring a tracheostomy. Stunted growth, malformed teeth, and slow mental development can occur if hypoparathyroidism develops in childhood. Overtreatment with vitamin D and calcium can cause hypercalcemia high blood calcium and sometimes interfere with kidney function. There is an increased risk of pernicious anemia, Addison's disease, cataract development, and Parkinson's disease. References Hurd, Robert 2006-10-25. Hypoparathyroidism. Medical Encyclopedia. Medline Plus. Retrieved on 2007-11-02. See also Hyperparathyroidism Pseudopseudohypoparathyroidism v d e Endocrine pathology: endocrine diseases E00-35, 240-259 Pancreas/ glucose metabolism Diabetes mellitus types: type 1, type 2, MODY, complications: coma, angiopathy, ketoacidosis, nephropathy, neuropathy, retinopathy Hypoglycemia - Hyperinsulinism - Zollinger-Ellison syndrome - insulin receptor Rabson-Mendenhall syndrome - Insulin resistance Hypothalamic/ pituitary axes Pituitary Hyperpituitarism Acromegaly, Hyperprolactinaemia, SIADH Hypopituitarism Sheehan's syndrome, Kallmann syndrome, Growth hormone deficiency, Diabetes insipidus Adiposogenital dystrophy - Empty sella syndrome - Pituitary apoplexy - ACTH deficiency Thyroid Hypothyroidism Iodine deficiency, Cretinism, Congenital hypothyroidism, Goitre, Myxedema Hyperthyroidism Graves disease, Toxic multinodular goitre, Teratoma with thyroid tissue or Struma ovarii Thyroiditis De Quervain's thyroiditis, Hashimoto's thyroiditis, Riedel's thyroiditis Euthyroid sick syndrome - Thyroid hormone resistance - Thyroid nodule Parathyroid Hypoparathyroidism Pseudohypoparathyroidism - Hyperparathyroidism Primary, Secondary, Tertiary Adrenal Adrenocortical hyperfunction: Cushing's syndrome Nelson's syndrome, Pseudo-Cushing's syndrome - Hyperaldosteronism Conn syndrome, Bartter syndrome CAH Lipoid, 3β, 11β, 17α, 21α Adrenal insufficiency Addison's disease, Waterhouse-Friderichsen syndrome - Hypoaldosteronism Gonads ovarian Polycystic ovary syndrome, Premature ovarian failure testicular 5-alpha-reductase deficiency, 17-beta-hydroxysteroid dehydrogenase deficiency general Hypogonadism, Delayed puberty, Precocious puberty Other Androgen insensitivity syndrome - Autoimmune polyendocrine syndrome - Carcinoid syndrome - Gigantism - Short stature Laron syndrome, Psychogenic dwarfism - Multiple endocrine neoplasia 1, 2 - Progeria - Woodhouse-Sakati syndrome - thymus Abscess of thymus, Thymus hyperplasia see also congenital, neoplasia Retrieved from http://en..org/wiki/Hypoparathyroidism Categories: Parathyroid disorders Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages العربية Deutsch Español Français 日本語 Polski Svenska This page was last modified on 13 August 2008, at 13:43
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