-sinthu sarathamani

Hypoparathyroidism is decreased function of the parathyroid glands with underproduction of parathyroid hormone

DEFINITION

phosphorouscalcium

absence of a pair of chromosome 22

Etiology unknown; sporadic (nonhereditary); onset before age

20 years; external ophthalmoplegia; complete heart

block.

Increased neuromuscular irritability

Including:

• Paresthesias (lips, tongue, fingers, feet)

• Muscle cramps

• Weakness

• Headaches

• Carpopedal spasms

Acute presentation may include:

• Tetany

• Seizures

• Altered mental state

• Congestive heart failure

• Stridor

Symptoms of longstanding hypoparathyroidism include:

Cataracts

Malformations of teeth

Intracranial calcifications

Renal stones

Renal failure

SYMPTOMSFROMHEAD TOFOOT

DIAGNOSTIC SIGNS

Chvostek’sTrousseau’s signs

Chvostek’s signAn abnormal reaction to the

stimulation of the facial nerve. When the facial nerve is tapped at the angle of the jaw (i.e. masseter muscle), the facial muscles on the same side of the face will contract momentarily (typically a twitch of the nose or lips) because of hypocalcemia

To elicit the sign, a blood pressure cuff is placed around the arm and inflated to a pressure greater than the systolic blood pressure and held in place for 3 minutes. This will occlude the brachial artery. In the absence of blood flow, the patient's hypocalcemia and subsequent neuromuscular irritability will induce spasm of the muscles of the hand and forearm. The wrist and metacarpophalangealjointsflex, the DIP and PIPjointsextend, and the fingers adduct

Investigations

• Primary

• hypoparathyroidism

PTH

ca

• Secondary hypoparathyroidism

PTH

ca

• Serum

• PTH and ca

levels

• to exclude vitamin D deficiency as a cause of hypocalcemia.

Measurement of 25-hydroxy vitamin D

•Hypomagnesemia may cause PTH deficiency and subsequent hypocalcemia

Serum magnesium

• PTH is a phosphaturic hormone. In its absence, phosphorus levels in the blood rise.

Serum phosphorus

MedicationSurgical Care Consultations

Diet

MEDICATION

Calcium salts and vitamin D are the mainstays of treatment.

CALCIUM SALTS:Calcium carbonateCalcium citrate

Calcium gluconate

Vitamin D preparationsErgocalciferol

DihydrotachysterolCalcifediolCalcitriol

SURGICAL CARE• Patients undergoing parathyroidectomy for parathyroid hyperplasia are

at high risk of developing permanent primary hypoparathyroidism.

• Patients may be treated with an autotransplant of a segment of parathyroid gland to prevent hypoparathyroidism.[5] This autotransplant is usually placed subcutaneously in the forearm or in the neck.

• If the autotransplantation fails, patients receive the same treatment that is administered to other patients with hypoparathyroidism.

Consultations

An endocrinologist should be involved in the care of all patients who have primary hypoparathyroidism or who are at risk of developing it

Diet

A diet rich in calcium content (ie, emphasizing dairy products)

is recommended for patients with primary

hypoparathyroidism.

“What is success? It is being able

to go to bed each night with your

soul at peace”

-Paulo coelho

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