Hypoparathyroidism | Causes | Clinical features and Treatment of Hypoparathyroidism

Hypoparathyroidism | Causes | Clinical features and Treatment of Hypoparathyroidism .

What is Hypoparathyroidism

Hypoparathyroidism is the condition caused due to inadequate secretion or action of parathyroid hormone (PTH)

Causes of Hypoparathyroidism

1. Post-ablative.

• Surgical.
• Radioiodine therapy.

2. Auto-immune.

• Sporadic.
• Familial.

3. Idiopathic./> 4. Toxins, drugs and infections are other causes along with hemochromatosis, doxorubicin and rifampicin.

5. Di George’s syndrome- in which there is congenital absence of thymus and parathyroid./> 6. Pseudo-hypoparathyroidism- this is a congenital disorder where there are metabolic and skeletal features are prominent and include round face, short neck, short metacarpals and metatarsals.

Clinical features of Hypoparathyroidism

• Neuromuscular irritability manifests as tetany. This may be the only symptom that directs attention to presence of hypoparathyroidism.
  
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• Tetany is characterized by a characteristic position- Hands in carpopedal spasm- it is seen as flexion of metacarpal joints, extension of inter-phalangeal joints and opposition of thumb.

Incipient tetany can be made out clinically by

• Trousseau’s signs- in which carpal spasm is produced by compressing upper arm with blood pressure cuff and maintaining blood pressure above systolic pressure for 2-5min.
• Chvostek’s sign- contraction of facial muscles seen on tapping over facial nerve in front of ear lobe. Children usually present with convulsions, dry skin, moniliasis, cataracts and papillo-edema are seen in some cases.
  
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  Morphological changes are commonly seen in long standing or congenital disorders. These are short stature, moon faces, short 4th metacarpals and metatarsals, malformed nails, loss of dental enamel and absence of roots or failure of eruption.

Hypoparathyroidism Pathogenesis

• Lack of PTH causes slowing of bone re-modeling, decreased calcium absorption from gut and increased urinary calcium excretion, all leading to hypocalcaemia.

Hypoparathyroidism Investigation

• Serum calcium levels are decreased.
• Elevated levels of serum inorganic phosphorus.
• Typical X-ray findings and evidence of metastatic calcification to diagnosis.

Treatment of Hypoparathyroidism

• Treatment has to be given life long.
• No attempt is made to replace PTH because it is less effective and expensive.
• Main aim of treatment is to improve calcium status of person.
• In emergency, when tetany takes place calcium is given in intravenous form as calcium gluconate.
• In chronic situations, aim is to increase gut absorption of calcium.
• Vitamin D is also administered in some form.
• Vitamin I, 25(OH)2D3 or calcitrol is ideal preparation because it is effective as such with quick onset of action.
• Treatment aims at keeping serum calcium levels around 9mg/dl.