Hypoparathyroidism

Reversible hypoparathyroidism occurs in children before the age of 16 as a result of a rare autoimmune disease. It has also been known to occur as a rare side effect of 131I treatment for Graves' disease or with metastases of malignant tumors. Other causes of reversible hypoparathyroidism include hypomagnesemia (which impairs PTH synthesis) and delayed maturation of the parathyroid glands.

In most cases, congenital hypoparathyroidism is sporadic, but it can be inherited as a genetic trait with varied patterns of inheritance (autosomal recessive, autosomal dominant, and X-linked recessive). Defects involve the genes that code for PTH or its receptors or proteins involved in normal parathyroid development.

The disease may occur at any age, in both sexes, and in all races and ethnicities. No specific life span considerations exist. The prevalence is equal in men and women and all ages may be affected.

HISTORY. History may reveal damage to the parathyroid glands during some form of neck surgery. The patient may report many GI symptoms, including abdominal pain, nausea and vomiting, diarrhea, and anorexia. Signs of hypocalcemia—such as paresthesia (numbness and tingling in the extremities), increased anxiety, headaches, irritability, and sometimes depression—may be reported. Some patients complain of difficulty swallowing or throat tightness. Others report difficulty with balancing and a history of falls or injuries.

PHYSICAL EXAMINATION. Note dry skin, thin hair with patchy areas of hair loss, ridged fingernails, and teeth in poor condition. The patient may speak with a hoarse voice or have unexplained wheezing. The patient may have neuromuscular irritability with involuntary tremors and muscle spasms. Check for Trousseau's (development of carpal spasm when a blood pressure cuff is inflated above systolic pressure for 3 minutes) and Chvostek's signs (twitching facial muscles when the facial nerve is tapped anterior to the ear).

PSYCHOSOCIAL. Patients may have altered behavior, exhibiting irritability, depression, and anxiety. The patient and significant others may describe an inability to cope with the physical manifestations of the disease and the stressors of daily life.

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