Updated: 8/6/2019

Hypoparathyroidism

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Introduction
  • Causes of ↓ PTH release include
    • accidental surgical excision (thyroidectomy)
    • autoimmune destruction of parathyroid glands
    • DiGeorge syndrome
      • congenital absence of parathyroid glands
    • hypomagnesemia
      • ↓ functional adenylate cyclase leading to ↓ PTH activity
  • Can also be caused by resistance of PTH
    • pseudohypoparathyroidism 
      • renal tubules do not respond in presence of PTH
        • aka Albright hereditary osteodystrophy
      • AD inheritance
Presentation
  • Symptoms
    • tetany (hypocalcemia)
  • Physical exam
    • Chvostek's sign
      • contraction of facial muscles when tapped rapidly
    • Trousseau's sign 
      • carpal spasm following occlusion of brachial artery with BP cuff
    • findings unique to pseudohypoparathyroidism (Albright hereditary osteodystrophy)
      • shortened 4th/5th digits
        • Turners syndrome only involves 5th digit
      • short stature
Evaluation
  • Serology
    • hypocalcemia
    • hyperphosphatemia
Treatment
  • Medical
    • calcium + calcitriol (D3) supplemenation
    • teriparatide
      • recombinant PTH
 

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(M1.EC.14.35) A 1-year-old boy presents to pediatrics clinic for a well-child visit. He has no complaints. He has a cleft palate and an abnormal facial appearance. He has been riddled with recurrent infections and is followed by cardiology for a ventricular septal defect (VSD). Vital signs are stable, and the patient's physical exam is benign. If this patient's medical history is part of a larger syndrome, what might one also discover that is consistent with the manifestations of this syndrome? Tested Concept

QID: 105433
1

Kidney stones

3%

(1/29)

2

B-cell deficiency

10%

(3/29)

3

A positive Chvostek's sign

72%

(21/29)

4

A shortened QT Interval

3%

(1/29)

5

Hypoactive deep tendon reflexes

10%

(3/29)

M 2 E

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