Hypoparathyroidism history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2]

Overview

The hallmark of acute hypocalcemia due to hypoparathyroidism is tetany. A positive history of neck surgery and symptoms of hypocalcemia are suggestive of hypoparathyroidism. The most common symptoms of hypoparathyroidism include tetany (paresthesia, carpopedal spasms, and circumoral numbness). Common symptoms of hypoparathyroidism include abdominal pain, biliary colic, fatigue, muscle cramps, myoclonic jerks, new onset seizure due to hypocalcemia or worsening of seizures, and painful menstruation. Less common symptoms of hypoparathyroidism include cognitive impairment, decreased concentration, hoarseness, palpitations, personality disturbances and/or mood changes, symptoms of acute cardiomyopathy, wheezing, and dyspnea.

History and Symptoms

History

Patients with hypoparathyroidism may have a positive history of:^[1]^[2]

History of neck surgery
A family history of hypocalcemia and/or hypoparathyroidism
A history of other autoimmune endocrinopathies (e.g., adrenal insufficiency)
A history of candidiasis
Immunodeficiency

Symptoms

Clinical symptoms depends on two features:^[3]
- Acuteness of hypocalcemia
- The absolute level of serum calcium
Patients presents dramatically and tends to have more symptoms if there is an acute hypocalcemia compared to patients with chronic hypocalcemia.^[4]

Common symptoms

Common symptoms of hypoparathyroidism include:^[3]^[5]

Tetany (hallmark of acute hypocalcemia)
- Paresthesia in fingertips, toes, perioral area
- Carpopedal spasms
- Circumoral numbness
Abdominal pain
Biliary colic
Fatigue
Muscle cramps
Myoclonic jerks
New onset seizure due to hypocalcemia or worsening of seizures^[6]

Less common symptoms

Less common symptoms of hypoparathyroidism include:^[3]^[5]

Cognitive impairment
Hoarseness (due to laryngospasm)
Palpitations due cardiac dysarrhythmias
Personality disturbances and/or mood changes
Symptoms of acute cardiomyopathy^[7]
Wheezing and dyspnea (due to bronchospasm)
Electrocardiographic changes that mimic myocardial infarction, or congestive heart failure (decreased cardiac contractility is related to low serum calcium and possibly parathyroid hormone deficiency, as parathyroid hormone receptors are present in cardiac myocytes).^[8]^[9]

References

↑ Brun JM (1982). “Juvenile autoimmune polyendocrinopathy”. Horm. Res. 16 (5): 308–16. PMID 7173823.
↑ Shoback D (2008). “Clinical practice. Hypoparathyroidism”. N. Engl. J. Med. 359 (4): 391–403. doi:10.1056/NEJMcp0803050. PMID 18650515.
↑ ^3.0 ^3.1 ^3.2 Abate EG, Clarke BL (2016). “Review of Hypoparathyroidism”. Front Endocrinol (Lausanne). 7: 172. doi:10.3389/fendo.2016.00172. PMC 5237638. PMID 28138323.
↑ Tohme JF, Bilezikian JP (1993). “Hypocalcemic emergencies”. Endocrinol. Metab. Clin. North Am. 22 (2): 363–75. PMID 8325292.
↑ ^5.0 ^5.1 Cooper MS, Gittoes NJ (2008). “Diagnosis and management of hypocalcaemia”. BMJ. 336 (7656): 1298–302. doi:10.1136/bmj.39582.589433.BE. PMC 2413335. PMID 18535072.
↑ Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L (2013). “Cardiovascular and renal complications to postsurgical hypoparathyroidism: a Danish nationwide controlled historic follow-up study”. J. Bone Miner. Res. 28 (11): 2277–85. doi:10.1002/jbmr.1979. PMID 23661265.
↑ Kudoh C, Tanaka S, Marusaki S, Takahashi N, Miyazaki Y, Yoshioka N, Hayashi M, Shimamoto K, Kikuchi K, Iimura O (1992). “Hypocalcemic cardiomyopathy in a patient with idiopathic hypoparathyroidism”. Intern. Med. 31 (4): 561–8. PMID 1633370.
↑ Wong CK, Lau CP, Cheng CH, Leung WH, Freedman B (1990). “Hypocalcemic myocardial dysfunction: short- and long-term improvement with calcium replacement”. Am. Heart J. 120 (2): 381–6. PMID 2382615.
↑ Kimura S, Yoshioka K (2014). “Parathyroid hormone and parathyroid hormone type-1 receptor accelerate myocyte differentiation”. Sci Rep. 4: 5066. doi:10.1038/srep05066. PMC 4052750. PMID 24919035.

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[pmid7173823-1] Brun JM (1982). “Juvenile autoimmune polyendocrinopathy”. Horm. Res. 16 (5): 308–16. PMID 7173823.

[pmid18650515-2] Shoback D (2008). “Clinical practice. Hypoparathyroidism”. N. Engl. J. Med. 359 (4): 391–403. doi:10.1056/NEJMcp0803050. PMID 18650515.

[pmid28138323-3] 3.0 ^3.1 ^3.2 Abate EG, Clarke BL (2016). “Review of Hypoparathyroidism”. Front Endocrinol (Lausanne). 7: 172. doi:10.3389/fendo.2016.00172. PMC 5237638. PMID 28138323.

[pmid8325292-4] Tohme JF, Bilezikian JP (1993). “Hypocalcemic emergencies”. Endocrinol. Metab. Clin. North Am. 22 (2): 363–75. PMID 8325292.

[pmid18535072-5] 5.0 ^5.1 Cooper MS, Gittoes NJ (2008). “Diagnosis and management of hypocalcaemia”. BMJ. 336 (7656): 1298–302. doi:10.1136/bmj.39582.589433.BE. PMC 2413335. PMID 18535072.

[pmid23661265-6] Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L (2013). “Cardiovascular and renal complications to postsurgical hypoparathyroidism: a Danish nationwide controlled historic follow-up study”. J. Bone Miner. Res. 28 (11): 2277–85. doi:10.1002/jbmr.1979. PMID 23661265.

[pmid1633370-7] Kudoh C, Tanaka S, Marusaki S, Takahashi N, Miyazaki Y, Yoshioka N, Hayashi M, Shimamoto K, Kikuchi K, Iimura O (1992). “Hypocalcemic cardiomyopathy in a patient with idiopathic hypoparathyroidism”. Intern. Med. 31 (4): 561–8. PMID 1633370.

[pmid2382615-8] Wong CK, Lau CP, Cheng CH, Leung WH, Freedman B (1990). “Hypocalcemic myocardial dysfunction: short- and long-term improvement with calcium replacement”. Am. Heart J. 120 (2): 381–6. PMID 2382615.

[pmid24919035-9] Kimura S, Yoshioka K (2014). “Parathyroid hormone and parathyroid hormone type-1 receptor accelerate myocyte differentiation”. Sci Rep. 4: 5066. doi:10.1038/srep05066. PMC 4052750. PMID 24919035.

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