Presentation
Abstract Organ-specific autoimmune endocrine disorders may present as single diseases or may occur together in polyendocrine syndromes. We present a report of 23-year-old female with Graves' disease and concurrent hypocalcemia. [ncbi.nlm.nih.gov]
Another unique feature of the presented case was the finding of hyperechogenicities in brain parenchyma on transcranial sonography (TCS). [omicsonline.org]
This report intends to highlight the clinical heterogeneity and varied presentation of APS-2. [ijem.in]
Entire Body System
- Asymptomatic
Khan AA, Bilezikian JP, Potts JT Jr; Guest Editors for the Third International Workshop on Asymptomatic Primary Hyperparathyroidism. The diagnosis and management of asymptomatic primary hyperparathyroidism revisited. [aafp.org]
Some patients with chronic hypoparathyroidism have a period of being relatively asymptomatic, and their biochemical abnormalities are found in a routine checkup or during the routine investigation of related but nonspecific symptoms (eg, fatigue, muscle [shifrinmd.com]
Symptoms and Signs Hypocalcemia is frequently asymptomatic. [merckmanuals.com]
[…] calcium and phosphorus levels in the body ( 1 ) Acute hypoparathyroidism: tetany that is mild (muscle cramps, perioral numbness, paresthesias of hands and feet) or severe (carpopedal spasm, laryngospasm, heart failure, seizures, stridor) Chronic: often asymptomatic [unboundmedicine.com]
- Amyloidosis
Causes related to infiltration of the parathyroid glands In addition to hemochromatosis and Wilson disease, parathyroid gland destruction has been reported as a result of metastatic disease, granulomatous disease, amyloidosis, syphilis, and progressive [emedicine.medscape.com]
Discussion Hypoparathyroidism is a rare pathological state either related to a genetic disease or secondary to surgery, irradiation, infiltration by metastases or systemic diseases such as amyloidosis, hemochromatosis or granulomatous conditions. 1 Hypoparathyroidism [academic.oup.com]
Pathologic involvement of the parathyroid glands can also occur in metastatic neoplasia, miliary tuberculosis, amyloidosis, and sarcoid, but clinical hypoparathyroidism rarely occurs in these conditions. Magnesium deficiency and excess. [hypopara.org]
- Euthyroid
Patient was euthyroid, but an increased level of serum anti-thyreoglobulin antibodies was found (Table 1). Cortisol and calcitonin levels were normal (Table 1). [omicsonline.org]
Cardiovascular
- Heart Disease
Zellweger syndrome Teratogenic effects Diabetic embryopathy Fetal alcohol syndrome Retinoid embryopathy Associational arhinencephalia and/or DiGeorge syndrome and the coloboma, heart disease, choanal atresia, retarded growth and development, genital anomalies [emedicine.medscape.com]
Initial assessment particular attention should be suspected in a patient with a minimum of 4 paypal nolvadex major criteria: alagille facies cholestasis congenital heart disease, hypothyroidism, viagra online london diabetes mellitus, hypoparathyroidism [miketnelson.com]
Molecular genetic analysis of the DiGeorge syndrome among Korean patients with congenital heart disease. Mol.Cells 9:72-77. 43. Monaco, G., C. Pignata, E. Rossi, and et al. 1991. DiGeorge anomaly associated with 10p deletion. [hypopara.org]
Musculoskeletal
- Muscle Cramp
Symptoms of hypoparathyroidism may include tingling in the lips, fingers, and toes; dry hair, brittle nails, and dry, coarse skin; muscle cramps and pain in the face, hands, legs, and feet ; cataracts ; dental problems; memory loss, headaches, and muscle [medicinenet.com]
Symptoms can range from quite mild (tingling in the hands, fingers, and around the mouth) to more severe forms of muscle cramps leading to severe spasms of the hands or feet. [metabolicleader.com]
Signs and symptoms include muscle cramps, abdominal pain, dry skin, brittle nails, cataracts, tetany, and convulsions. Definition (NCI_CTCAE) A disorder characterized by a decrease in production of parathyroid hormone by the parathyroid glands. [fpnotebook.com]
Hypoparathyroidism Symptoms Symptoms can range from quite mild (tingling in the hands, fingers, and around the mouth) to more severe forms of muscle cramps. [endocrineweb.com]
An underactive parathyroid gland can cause numerous symptoms including tingling in the lips, fingers, and toes; muscle cramps; pain in the abdomen, face, legs, and feet; weakness or fatigue; and dry hair and skin. [counsyl.com]
- Fracture
Our patient developed vertebral compression fractures at age 10, shortly after hypoparathyroidism was diagnosed. She continued to have low lumbar bone mass until age 16, when a dual energy x-ray absorptiometry (DEXA) revealed a Z score of - 2.2 SD. [ncbi.nlm.nih.gov]
Families that do not have to be considered for generic viagra wholesale severely displaced supportive sling or figure paypal nolvadex of eight zones defines the fracture fragments. [miketnelson.com]
Hyperparathyroidism is diagnosed after a blood test shows: high levels of parathyroid hormone high levels of blood calcium, often with low levels of phosphorus A DEXA scan (a bone density X-ray) can help detect bone loss, fractures or bone softening, [nhs.uk]
These include the NIH Post-menopausal Estrogen/Progestin Interventions Trial (PEPI), Merck's Fracture Intervention Trial (FIT), Lilly's Multiple Outcomes of Raloxifene Intervention (MORE), and Lilly's registration trial of recombinant PTH(1-34) in the [books.google.de]
Possible diagnoses: bone disease, insufficiency fractures, osteomalacia, osteoporosis Table 1. [aafp.org]
- Muscle Weakness
Addison disease can cause fatigue, muscle weakness, weight loss, low blood pressure, and changes in skin coloration. There are numerous other symptoms which can also occur in people with PAS-1. [counsyl.com]
If you do have symptoms, they can be wide ranging and include: depression tiredness feeling thirsty and peeing a lot feeling sick and losing your appetite muscle weakness constipation tummy pain loss of concentration mild confusion Left untreated, high [nhs.uk]
When high levels of calcium do cause symptoms, they can be mild or general, including: depression fatigue feeling thirsty and passing a lot of urine feeling sick and losing your appetite muscle weakness constipation tummy pain loss of concentration mild [your.md]
weakness Hypercalcemia Movement disorders, parkinsonism Hypocalcemia Other: head, ears, eyes, nose, and throat Neck mass or lymphadenopathy Granulomatous disease, parathyroid cancer, large parathyroid adenoma Other: ophthalmologic Cataract Hypocalcemia [aafp.org]
Muscle weakness, pain, and typical bone deformities can occur. [merckmanuals.com]
Neurologic
- Paresthesia
Patients with hypoparathyroidism most often present with paresthesia, cramps, or tetany, but the disorder also may manifest acutely with seizures, bronchospasm, laryngospasm, or cardiac rhythm disturbances. [endocrine-abstracts.org]
Symptoms Signs and symptoms of hypoparathyroidism can include: Tingling or burning (paresthesia) in your fingertips, toes and lips Muscle aches or cramps in your legs, feet, abdomen or face Twitching or spasms of your muscles, particularly around your [mayoclinic.org]
Paresthesias. These are characterized by sensory symptoms of odd, tingling sensations or pins and needles feelings in your lips, tongue, fingers and feet. Loss of consciousness with convulsions (grand mal seizures). [checkorphan.org]
Manifestations include paresthesias, tetany, and, when severe, seizures, encephalopathy, and heart failure. Diagnosis involves measurement of serum calcium with adjustment for serum albumin concentration. [merckmanuals.com]
[…] below -- Basics Description Deficient or absent secretion of parathyroid hormone (PTH), a major hormone regulator of serum calcium and phosphorus levels in the body ( 1 ) Acute hypoparathyroidism: tetany that is mild (muscle cramps, perioral numbness, paresthesias [unboundmedicine.com]
- Irritability
Generally, a central venous catheter is recommended, as the calcium can irritate peripheral veins and cause phlebitis. [en.wikipedia.org]
[…] quickly (for example, after neck surgery) can have the following symptoms: a tingling sensation in the hands or feet or around the mouth (paraesthesia) unusual muscle movements, such as jerking, twitching or muscle spasms muscle cramps feeling tired, irritable [your.md]
Calcium chloride should be avoided because it is irritating and potentially sclerosing to veins. Ten milliliters of 10% calcium gluconate diluted in 100 mL 5% dextrose (D5W) is infused intravenously over 5-10 minutes. [shifrinmd.com]
Major clinical manifestations of hypocalcemia are due to disturbances in cellular membrane potential, resulting in neuromuscular irritability. Muscle cramps involving the back and legs are common. [merckmanuals.com]
Workup
Serum
- Hypoglycemia
Hypothyroidism in a patient with type I diabetes may also present with fatigue, decreased insulin requirements, and hypoglycemia, whereas hyperthyroidism is associated with increased insulin requirements and hyperglycemia. [hopkinsguides.com]
E16.2 Hypoglycemia, unspecified E16.3 Increased secretion of glucagon E16.4 Increased secretion of gastrin E16.8 Other specified disorders of pancreatic internal secretion E16.9 Disorder of pancreatic internal secretion, unspecified E20 Hypoparathyroidism [icd10data.com]
[…] pathophysiology and clinical characteristics Nambam, B; Winter, WE; Schatz, DA Autoimmune polyglandular syndromes Obermayer-Straub, P; Manns, MP Insulin autoimmune syndrome (Hirata disease) as differential diagnosis in patients with hyperinsulinemic hypoglycemia [deepdyve.com]
Treatment
Make the best clinical decisions with an enhanced emphasis on evidence-based practice and expert opinions on treatment strategies. Zero in on the most relevant and useful references with the aid of a more focused, concise bibliography. [books.google.de]
Extensive cancer radiation treatment of your face or neck. Radiation can result in destruction of your parathyroid glands, as can radioactive iodine treatment for hyperthyroidism, occasionally. [checkorphan.org]
Other novel parathyroid autoantigens are starting to be elucidated, suggesting that new approaches to treatment, such as CaSR antagonists or agonists (calcilytics/calcimimetics), may be worthwhile. [ncbi.nlm.nih.gov]
Prognosis
What is the prognosis for a person with Polyglandular Autoimmune Syndrome Type 1? The prognosis for a person with PAS-1 varies depending on the number and severity of his or her symptoms. [counsyl.com]
Hypoparathyroidism prognosis If hypoparathyroidism is adequately treated with calcium and vitamin D, the outlook (prognosis) is good. However, this relies on you taking medication daily for life. [patient.info]
Prognosis - Hypoparathyroidism Hypoparathyroidism may result in numerous complications if not treated. The following complications are due to low calcium levels, most of which are likely to improve with adequate treatment: Tetany. [checkorphan.org]
Etiology
They are organised into groups, and further divided into clinical, etiological or histopathological sub-types. [orpha.net]
One logical way to classify the different etiologies of hypocalcemia is to break them down into LOW PTH STATES and HIGH PTH STATES. Today I'll review the HYPOCALCEMIA WITH LOW PH STATES, or in other words, the causes of hypoparathyroidism. [renalfellow.blogspot.com]
Since we were not able to measure CaSR antibodies we relied on other clinical and laboratory findings that supported our hypothesis of autoimmune etiology. [omicsonline.org]
Presentation of hypoparathyroidism: etiologies and clinical features. J Clin Endocrinol Metab. 2016 Jun;101:2300-12. Bollerslev J, Rejnmark L, Marcocci C, Shoback DM, Sitges-Serra A, Van Biesen W, Dekkers OM. [rarediseases.org]
Prevalence Affects 24 to 37/100,000 persons per year ( 1 ) Autosomal dominant hypocalcemia with hypercalciuria (ADHH): 1/70,000 typically in infancy with hypocalcemic seizures Etiology and Pathophysiology PTH aids in regulating calcium homeostasis: Mobilizes [unboundmedicine.com]
Epidemiology
It opens by addressing in detail the anatomy and physiology of the parathyroids and describing the epidemiology and clinical presentation of hypoparathyroidism. [books.google.de]
Epidemiology and diagnosis of hypoparathyroidism. J Clin Endocrinol Metab. 2016 Jun;101:2284-99. Ferre EM, Rose SR, Rosenzweig SD, et al. [rarediseases.org]
[Polyglandular autoimmune syndrome type II: epidemiology and forms of manifestation]. Dtsch Med Wochenschr. 1999;124(49):1476-81. [PMID:10629665] Comment: Reviews epidemiology of PAS II. Eisenbarth G, Wilson P, Ward F, et al. [hopkinsguides.com]
Epidemiology and diagnosis of hypoparathyroidism. J Clin Endocrinol Metab. 2016;101(6):2284-2299. PMID: 26943720 www.ncbi.nlm.nih.gov/pubmed/26943720. Darr EA, Sritharan N, Pellitteri PK, Sofferman RA, Randolph GW. [medlineplus.gov]
Epidemiology More common in women; affects all ages Incidence Most common after surgical procedure of the anterior neck (75% of all cases). [unboundmedicine.com]
Pathophysiology
This edition has been thoroughly revised by world-renowned contributors to reflect recent developments in renal pathophysiology. [books.google.de]
Masia, R; Peyton, S; Lauwers, GY Polyglandular autoimmune syndromes Maurer, A; Schwarting, A; Kahaly, GJ Autoimmune polyglandular syndromes Michels, AW; Gottlieb, PA IgG4 antibodies in autoimmune polyglandular disease and IgG4-related endocrinopathies: pathophysiology [deepdyve.com]
Here we discuss the pathophysiology and diagnostic aspects of this treatable disease. [omicsonline.org]
Hypoparathyroidism in the adult: epidemiology, diagnosis, pathophysiology, target organ involvement, treatment and challenges for future research. J Bone Min Res. 2011; 26: 2317-37. Khan MI, Waguespack SG, Hu MI. [rarediseases.org]
Hypoparathyroidism in the adult: epidemiology, diagnosis, pathophysiology, target-organ involvement, treatment, and challenges for future research. J Bone Miner Res. 2011;26(10):2317–37. DOI : 10.1002/jbmr.483. [ncbi.nlm.nih.gov]
Prevention
[…] to prevent hypoparathyroidism. [mayoclinic.org]
If your calcium level becomes drastically low, you may need to have intravenous (IV) calcium to quickly get it into your bloodstream to prevent serious complications. [verywell.com]
Prevention - Hypoparathyroidism There are no specific actions you can take to prevent hypoparathyroidism. [checkorphan.org]
The inherited forms tend to arise from abnormal genes that may: encode abnormal forms of PTH or its receptor prevent normal conduction of cell signals from the PTH receptor to the nucleus prevent normal gland development before birth. [endocrineweb.com]
Early detection of the disease and its component symptoms is important for preventing life-threatening scenarios. With careful monitoring, it is possible to have a normal or near-normal lifespan. [counsyl.com]