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Hypoparathyroidism

Background knowledge ๐Ÿง 

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 ๐ŸŒก๏ธ

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 ๐Ÿงช

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 hypocalcemia).

Management ๐Ÿฅผ

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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