Hypoparathyroidism

Medicine > Endocrine & metabolic

Background knowledge 🧠

Definition

Hypoparathyroidism is characterised by insufficient production of parathyroid hormone (PTH).
Leads to hypocalcaemia and hyperphosphataemia.
Can be congenital or acquired.

Epidemiology

Rare condition.
More common in females.
Incidence increases with age.
Can occur post-thyroidectomy or neck surgery.

Aetiology and Pathophysiology

Surgical removal or damage to parathyroid glands.
Autoimmune destruction.
Genetic disorders (e.g., DiGeorge syndrome).
Infiltrative diseases (e.g., haemochromatosis).
Radiation-induced damage.
Idiopathic causes.

Types

Congenital hypoparathyroidism.
Acquired hypoparathyroidism.
Autoimmune hypoparathyroidism.
Pseudohypoparathyroidism (PTH resistance).

Clinical Features 🌡️

Symptoms

Occur mainly due to hypocalcaemia.
Muscle cramps and spasms (tetany).
Paresthesias (tingling sensation).
Fatigue and weakness.
Anxiety and depression.
Dry skin and brittle nails.
Cognitive disturbances (e.g., memory loss).

Signs

Occur mainly due to hypocalcaemia.
Chvostek’s sign (facial muscle contraction).
Trousseau’s sign (carpopedal spasm).
Hyperreflexia.
Laryngospasm (severe cases).
Cardiac arrhythmias.
Cataracts (chronic hypocalcaemia).

Investigations 🧪

Tests

Serum calcium (low) and phosphate (high).
PTH levels (low or inappropriately normal).
Serum magnesium levels (low).
24-hour urinary test: Urinary calcium excretion (low).
ECG (prolonged QT interval in severe hypocalcaemia).

Management 🥼

Management

Calcium and vitamin D supplementation.
Lifestyle: high-calcium, low phosphorus diet.
Magnesium supplementation (if low).
PTH replacement therapy (recombinant PTH).
Regular monitoring of serum calcium and phosphate.
Management of complications (e.g., cataracts).

Complications

Seizures.
Cardiac arrhythmias.
Laryngospasm.
Bronchospasm.
Cataracts.
Psychiatric disturbances.

Prognosis

Variable, depends on cause and treatment adherence.
Good with adequate supplementation and monitoring.
Chronic complications possible if poorly managed.
Regular follow-up essential.

Key Points

Recognise symptoms and signs early.
Initiate appropriate calcium and vitamin D supplementation.
Monitor serum calcium and phosphate regularly.
Educate patients on adherence to treatment.
Consider genetic testing in congenital cases.

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