Hypoparathyroidism Classification & external resources
ICD-10
| E20., E89.2, P71.4
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ICD-9
| 252.1
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DiseasesDB
| 6490
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eMedicine
| med/1131 emerg/276 ped/1125
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MeSH
| D007011
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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.
Additional recommended knowledge
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:
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
References
- Hurd, Robert (2006-10-25). Hypoparathyroidism. Medical Encyclopedia. Medline Plus. Retrieved on 2007-11-02.
See also
Endocrine pathology: endocrine diseases (E00-35, 240-259) |
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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 |
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Pancreas | Diabetes mellitus (type 1, type 2, coma, angiopathy, ketoacidosis, nephropathy, neuropathy, retinopathy) - Hypoglycemia - Hyperinsulinism - Zollinger-Ellison syndrome |
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Parathyroid | Hypoparathyroidism (Pseudohypoparathyroidism) - Hyperparathyroidism (Primary, Secondary, Tertiary) |
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Pituitary | Hyperpituitarism (Acromegaly, Hyperprolactinaemia, SIADH) - Hypopituitarism (Simmonds' disease/Sheehan's syndrome, Kallmann syndrome, Growth hormone deficiency, Diabetes insipidus) - Adiposogenital dystrophy - Empty sella syndrome |
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Adrenal | Cushing's syndrome (Nelson's syndrome, Pseudo-Cushing's syndrome) - CAH (due to 21-hydroxylase deficiency) - Hyperaldosteronism (Conn syndrome, Bartter syndrome) - Adrenal insufficiency (Addison's disease) - Hypoaldosteronism |
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Gonads | ovarian dysfunction (Polycystic ovary syndrome, Premature ovarian failure) - testicular dysfunction (5-alpha-reductase deficiency) - general (Hypogonadism, Delayed puberty, Precocious puberty) |
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Other | Autoimmune polyendocrine syndrome - Carcinoid syndrome - Short stature (Laron syndrome, Psychogenic dwarfism) - Gigantism - Androgen insensitivity syndrome - Progeria - Multiple endocrine neoplasia (1, 2) |
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