Updated: 10/10/2016

Hypoparathyroidism

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Introduction
  • Decreased production of parathyroid hormone (PTH) by chief cells of the parathyroid gland resulting in 
    • decreased plasma calcium levels 
    • increased plasma phosphate levels 
    • decreased 1,25(OH)2 Vitamin D levels
  • Etiology 
    • iatrogenic 
      • thyroidectomy most common cause
  • Pathophysiology
    • decreased PTH levels cause
      • decreased urinary excretion of phosphate at kidneys
        • serum phosphate levels increase
      • decreased conversion of inactive form of vitamin D to active form 
        • 1,25(OH)2-vitamin levels decrease
  • Prognosis
    • no current hormone replacement therapy available
    • treatment is aimed at supplementing vitamin D and calcium levels
Presentation
  • Symptoms
    • hypocalcemia 
      • more common in hypoparathyroidism
        • neuromuscular irritability
          • Chvostek's sign
          • seizures
          • tetany
        • cataracts
        • fungal infections of the nail
        • hair loss 
        • skin changes
          • vitiligo
          • blotchiness of skin 
Imaging
  • Radiographs
    • skull
      • basal ganglia calcification   
Evaluation
  • Labs
    • decreased
      • PTH
      • calcium
      • 1,25-Vit D
      • urinary calcium
    • increased 
      • serum phosphate
    • normal 
      • alkaline phosphatase
  • pH
    • alkalosis increases albumin binding to ionized calcium
      • leads to hypocalcemia
  • EKG
    • prolonged QT interval  

 
Serum Ca
Serum Phos
PTH
Common Cause
Hyperparathyroidism
adenoma
Hypoparathyroidism
thyroidectomy (including parathyroid)
Ectopic PTH
malignancy
Vit D malabsorption
celiac disease, other GI disease
hypo vit D with no phosphate excretion from the kidney 
renal failure, pseudo
hypoparathyroidism
 
Treatment
  • Nonoperative
    •  calcium and vitamin D supplementation
      • indications
        • decreased serum calcium level
        • decreased levels of vitamin D
      • outcomes 
        • must monitor labs on a regular basis 
 

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Questions (1)

(OBQ11.58) A patient with chronic renal disease would expect which of the following endocrine abnormalities? Tested Concept

QID: 3481
1

Decreased production of PTH

10%

(216/2256)

2

No change in production of PTH

2%

(49/2256)

3

Increased production of PTH

87%

(1969/2256)

4

Increased production of TSH

1%

(13/2256)

5

Decreased production of TSH

0%

(5/2256)

L 1 C

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