Extensive bilateral intracranial calcifications and seizure in iatrogenic hypoparathyroidism: A case report

Calcification beyond basal ganglia is rare in postoperative permanent hypoparathyroidism. We report extensive bilateral intracranial calcifications involving basal ganglia, thalamus, cerebellum, and cerebral cortex in a 56-year-old lady who presented with carpopedal spasm, seizure, and severe hypocalcemia after 20 years of near-total thyroidectomy.

Normo-Calcemic Tetany in a Patient with Hypokalemic Periodic Paralysis of Sjogren’s Syndrome: Neuromuscular Excitability Secondary to the ‘Forgotten Cation’

: A young lady, a known case of Sjogren’s syndrome, presented to our hospital with hypokalemic flaccid paralysis requiring ventilatory support. She was investigated and found to have severe hypokalemia and metabolic acidosis. During her hospitalization, she had severe persistent carpopedal spasm with normal ionized calcium. Following further evaluation, there was evidence of hypomagnesemia. The spasms were improved after her hypomagnesemia was corrected. This case report illustrate the role of hypomagnesemia in neurological abnormalities in hospitalized patients.

Idiopathic Hypoparathyroidism: Still a Diagnostic Conundrum – A Tertiary Centre Experience

Idiopathic hypoparathyroidism leads to hypocalcemia and hyperphosphatasemia and usually has a genetic aetiology. The variable but often subtle signs and symptoms usually lead to a misdiagnosis of hypoparathyroidism. Case records of 32 patients of idiopathic hypoparathyroidism admitted over a period of five years were analysed. There was a lag period of 5.94 years from the onset of symptoms to the diagnosis. Carpopedal spasm was the most common indication for admission to the hospital. Trivial symptoms such as fatigue (84%) and paresthesia (62.5%) were the most common reported symptoms. A sum of 46.5% of the patients were on antiepileptic drugs before the correct diagnosis of hypoparathyroidism was made. This observation emphasized that Calcium profile should be obtained in patients with history of paresthesia and seizure to avoid the long delay in diagnosis of hypoparathyroidism.

Teenage Tachypnea

This case involves a young woman sent from a psychiatric hospital to the emergency department for assessment. Her chief complaint is intermittent shortness of breath. According to the psychiatrist’s note, she has experienced frequent episodes of uncontrollable hyperventilation, associated with carpopedal spasm and loss of consciousness in the past. There is concern she may have a chest infection. A chest X-ray appears to exclude a chest infection as an explanation of her symptoms, and arrangements are made to transfer her back to the psychiatric facility with a diagnosis of exacerbation of anxiety state. Unexpectedly, there is a sudden deterioration in the patient’s condition, which proves fatal.

FREQUENCY, DISTRIBUTION AND PRESENTATION OF HYPOCALCEMIA IN BETA THALASSEMIA MAJOR

Background: Disturbance of calcium hemostasis is common in patients of ß-thalassemia major. The objectives of this study were to determine the frequency, distribution and presentation of hypocalcemia in ß-thalassemia major children. Materials and Methods: This cross-sectional study was conducted in Fatimid Foundation Peshawar, Pakistan from to June 2015 to August 2015. 100 patients of ß-thalassemia major, aged 5-20 years were enrolled. After history and examination, serum calcium levels were determined through semi-automated analyzer Microlab 200. Those having levels less than 8.6 mg/dl were labelled as hypocalcemics. Sex, hypocalcemia in ß-thalassemia major, symptomatic hypocalcemia, presence of paresthesias & numbness, myalgias, hyperpigmentation and carpopedal spasm were variables. Frequency and percentage were calculated for all variables. Observed to expected frequencies of all variables were analyzed by chi-square goodness-of-fit test. Results: The frequency of hypocalcemia in ß-thalassemia major was 49/100 (49%), including 25 boys and 24 girls. The frequency of symptomatic hypocalcemia in ß-thalassemia major was 15/49 (30.61%). Paresthesias & numbness was present in 7/49 (14.29%) cases, hyperpigmentation in 6/49 (12.24%), myalgias in 3/49 (6.12%) and carpopedal spasm in 2/49 (4.08%) cases. The frequency of hypocalcemia in ß-thalassemia major and frequency of symptomatic hypocalcemia were higher in our sample than expected for the population. The frequency of paresthesia & numbness and of carpopedal spasm were similar while that of hyperpigmentation and myalgias were lower than expected. Conclusion: Hypocalcemia in ß-thalassemia major is very prevalent and mostly asymptomatic and chronic, therefore calcium levels of such patients should be periodically assessed and calcium supplementation advised where necessary.

Parathyroid, Adrenal, Gonadal, and Pituitary Disease

Endocrine disorders can cause diverse changes in cognition and affect as well as changes in neuromuscular function that may simulate primary neurologic disease, and they generally require a specialized endocrine workup to make a diagnosis. For example, hypoparathyroidism, which may be congenital (e.g., DiGeorge syndrome or Kearns-Sayre syndrome) or disease-acquired (e.g., autoimmune hypoparathyroidism) can present as neuromuscular irritability or tetany due to hypocalcemia, the most distinctive features, which may manifest as carpopedal spasm or laryngospasm. Primary hyperparathyroidism is the most common cause of hypercalcemia and is usually due to oversecretion of PTH by a solitary adenoma of the parathyroid glands. This chapter covers most common primary endocrine disorders that can present as neurological disorders.

Hypomagnesaemia Posing as Hypoparathyroidism

Persistent hypocalcaemia usually is a presentation of hypoparathyroidism. When it is coupled with low parathormone levels the diagnosis seems almost certain. However, the fact that hypomagnesaemia can give rise to both hypocalcaemia and low parathormone levels gives us points to ponder. This case depicts a young woman soon after childbirth presenting with carpopedal spasm and biochemical abnormalities. Subsequent correction of hypomagnesaemia readjusts calcium, potassium and parathormone levels.J Enam Med Col 2015; 5(3): 179-181