Hypoparathyroidism history and symptoms: Difference between revisions
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==Overview== | ==Overview== | ||
The hallmark of acute [[hypocalcemia]] due to [[hypoparathyroidism]] is [[tetany]]. A positive history of [[neck surgery]] and symptoms of [[hypocalcemia]] | 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 spasm|carpopedal spasms]], and circumoral [[numbness]]). Common [[symptoms]] of hypoparathyroidism include [[abdominal pain]], [[biliary colic]], [[fatigue]], [[muscle cramps]], [[Myoclonic jerk|myoclonic jerks]], new onset [[seizure]] due to [[hypocalcemia]] or worsening of [[Seizure|seizures]], and [[painful menstruation]]. Less common [[symptoms]] of hypoparathyroidism include [[Cognitive impairment|cognitive impairmen]]<nowiki/>t, [[decreased concentration]], [[hoarseness]], [[Palpitation|palpitations]], personality disturbances and/or mood changes, [[symptoms]] of acute [[cardiomyopathy]], [[Wheeze|wheezing]], and [[dyspnea]]. | ||
==History and Symptoms== | ==History and Symptoms== | ||
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===Symptoms=== | ===Symptoms=== | ||
*Clinical symptoms depends on two features:<ref name="pmid28138323">{{cite journal |vauthors=Abate EG, Clarke BL |title=Review of Hypoparathyroidism |journal=Front Endocrinol (Lausanne) |volume=7 |issue= |pages=172 |year=2016 |pmid=28138323 |pmc=5237638 |doi=10.3389/fendo.2016.00172 |url=}}</ref> | *Clinical [[symptoms]] depends on two features:<ref name="pmid28138323">{{cite journal |vauthors=Abate EG, Clarke BL |title=Review of Hypoparathyroidism |journal=Front Endocrinol (Lausanne) |volume=7 |issue= |pages=172 |year=2016 |pmid=28138323 |pmc=5237638 |doi=10.3389/fendo.2016.00172 |url=}}</ref> | ||
**Acuteness of [[hypocalcemia]] | **Acuteness of [[hypocalcemia]] | ||
**The absolute level of serum [[calcium]] | **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]].<ref name="pmid8325292">{{cite journal |vauthors=Tohme JF, Bilezikian JP |title=Hypocalcemic emergencies |journal=Endocrinol. Metab. Clin. North Am. |volume=22 |issue=2 |pages=363–75 |year=1993 |pmid=8325292 |doi= |url=}}</ref> | *Patients presents dramatically and tends to have more [[symptoms]] if there is an acute [[hypocalcemia]] compared to patients with chronic [[hypocalcemia]].<ref name="pmid8325292">{{cite journal |vauthors=Tohme JF, Bilezikian JP |title=Hypocalcemic emergencies |journal=Endocrinol. Metab. Clin. North Am. |volume=22 |issue=2 |pages=363–75 |year=1993 |pmid=8325292 |doi= |url=}}</ref> | ||
====Common symptoms==== | ====Common symptoms==== | ||
Common symptoms of hypoparathyroidism include:<ref name="pmid28138323">{{cite journal |vauthors=Abate EG, Clarke BL |title=Review of Hypoparathyroidism |journal=Front Endocrinol (Lausanne) |volume=7 |issue= |pages=172 |year=2016 |pmid=28138323 |pmc=5237638 |doi=10.3389/fendo.2016.00172 |url=}}</ref><ref name="pmid18535072">{{cite journal |vauthors=Cooper MS, Gittoes NJ |title=Diagnosis and management of hypocalcaemia |journal=BMJ |volume=336 |issue=7656 |pages=1298–302 |year=2008 |pmid=18535072 |pmc=2413335 |doi=10.1136/bmj.39582.589433.BE |url=}}</ref> | Common [[symptoms]] of hypoparathyroidism include:<ref name="pmid28138323">{{cite journal |vauthors=Abate EG, Clarke BL |title=Review of Hypoparathyroidism |journal=Front Endocrinol (Lausanne) |volume=7 |issue= |pages=172 |year=2016 |pmid=28138323 |pmc=5237638 |doi=10.3389/fendo.2016.00172 |url=}}</ref><ref name="pmid18535072">{{cite journal |vauthors=Cooper MS, Gittoes NJ |title=Diagnosis and management of hypocalcaemia |journal=BMJ |volume=336 |issue=7656 |pages=1298–302 |year=2008 |pmid=18535072 |pmc=2413335 |doi=10.1136/bmj.39582.589433.BE |url=}}</ref> | ||
*[[Tetany]] (hallmark of acute [[hypocalcemia]]) | *[[Tetany]] (hallmark of acute [[hypocalcemia]]) | ||
*[[Paresthesia]] in [[Fingertip|fingertips]], [[Toe|toes]], [[perioral]] area | **[[Paresthesia]] in [[Fingertip|fingertips]], [[Toe|toes]], [[perioral]] area | ||
*[[Carpopedal spasm|Carpopedal spasms]] | **[[Carpopedal spasm|Carpopedal spasms]] | ||
*Circumoral [[numbness]] | **Circumoral [[numbness]] | ||
*[[Abdominal pain]] | *[[Abdominal pain]] | ||
*[[Biliary colic]] | *[[Biliary colic]] | ||
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*[[Muscle cramps]] | *[[Muscle cramps]] | ||
*[[Myoclonic jerk|Myoclonic jerks]] | *[[Myoclonic jerk|Myoclonic jerks]] | ||
*New onset [[seizure]] due to [[hypocalcemia]] or worsening of [[Seizure|seizures]] | *New onset [[seizure]] due to [[hypocalcemia]] or worsening of [[Seizure|seizures]]<ref name="pmid23661265">{{cite journal |vauthors=Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L |title=Cardiovascular and renal complications to postsurgical hypoparathyroidism: a Danish nationwide controlled historic follow-up study |journal=J. Bone Miner. Res. |volume=28 |issue=11 |pages=2277–85 |year=2013 |pmid=23661265 |doi=10.1002/jbmr.1979 |url=}}</ref> | ||
====Less common | ====Less common symptoms==== | ||
Less common symptoms of hypoparathyroidism include:<ref name="pmid28138323">{{cite journal |vauthors=Abate EG, Clarke BL |title=Review of Hypoparathyroidism |journal=Front Endocrinol (Lausanne) |volume=7 |issue= |pages=172 |year=2016 |pmid=28138323 |pmc=5237638 |doi=10.3389/fendo.2016.00172 |url=}}</ref><ref name="pmid18535072">{{cite journal |vauthors=Cooper MS, Gittoes NJ |title=Diagnosis and management of hypocalcaemia |journal=BMJ |volume=336 |issue=7656 |pages=1298–302 |year=2008 |pmid=18535072 |pmc=2413335 |doi=10.1136/bmj.39582.589433.BE |url=}}</ref> | Less common [[symptoms]] of hypoparathyroidism include:<ref name="pmid28138323">{{cite journal |vauthors=Abate EG, Clarke BL |title=Review of Hypoparathyroidism |journal=Front Endocrinol (Lausanne) |volume=7 |issue= |pages=172 |year=2016 |pmid=28138323 |pmc=5237638 |doi=10.3389/fendo.2016.00172 |url=}}</ref><ref name="pmid18535072">{{cite journal |vauthors=Cooper MS, Gittoes NJ |title=Diagnosis and management of hypocalcaemia |journal=BMJ |volume=336 |issue=7656 |pages=1298–302 |year=2008 |pmid=18535072 |pmc=2413335 |doi=10.1136/bmj.39582.589433.BE |url=}}</ref> | ||
*[[Cognitive impairment]] | *[[Cognitive impairment]] | ||
*[[Hoarseness]] (due to [[laryngospasm]]) | *[[Hoarseness]] (due to [[laryngospasm]]) | ||
*[[Palpitation|Palpitations]] due [[cardiac]] dysarrhythmias | *[[Palpitation|Palpitations]] due [[cardiac]] dysarrhythmias | ||
*Personality disturbances and/or mood changes | *Personality disturbances and/or mood changes | ||
*Symptoms of acute [[cardiomyopathy]] | *[[Symptoms]] of acute [[cardiomyopathy]]<ref name="pmid1633370">{{cite journal |vauthors=Kudoh C, Tanaka S, Marusaki S, Takahashi N, Miyazaki Y, Yoshioka N, Hayashi M, Shimamoto K, Kikuchi K, Iimura O |title=Hypocalcemic cardiomyopathy in a patient with idiopathic hypoparathyroidism |journal=Intern. Med. |volume=31 |issue=4 |pages=561–8 |year=1992 |pmid=1633370 |doi= |url=}}</ref> | ||
*[[Wheezing]] and [[dyspnea]] (due to [[bronchospasm]]) | *[[Wheezing]] and [[dyspnea]] (due to [[bronchospasm]]) | ||
*Electrocardiographic changes that mimic [[myocardial infarction]], or [[congestive heart failure]] (decreased [[cardiac contractility]] is related to [[Hypocalcemia|low serum calcium]] and possibly parathyroid hormone deficiency, as parathyroid hormone receptors are present in [[cardiac myocytes]]).<ref name="pmid24919035">{{cite journal |vauthors=Kimura S, Yoshioka K |title=Parathyroid hormone and parathyroid hormone type-1 receptor accelerate myocyte differentiation |journal=Sci Rep |volume=4 |issue= |pages=5066 |year=2014 |pmid=24919035 |pmc=4052750 |doi=10.1038/srep05066 |url=}}</ref> | *[[Electrocardiographic]] changes that mimic [[myocardial infarction]], or [[congestive heart failure]] (decreased [[cardiac contractility]] is related to [[Hypocalcemia|low serum calcium]] and possibly [[parathyroid hormone]] deficiency, as [[parathyroid hormone]] receptors are present in [[cardiac myocytes]]).<ref name="pmid2382615">{{cite journal |vauthors=Wong CK, Lau CP, Cheng CH, Leung WH, Freedman B |title=Hypocalcemic myocardial dysfunction: short- and long-term improvement with calcium replacement |journal=Am. Heart J. |volume=120 |issue=2 |pages=381–6 |year=1990 |pmid=2382615 |doi= |url=}}</ref><ref name="pmid24919035">{{cite journal |vauthors=Kimura S, Yoshioka K |title=Parathyroid hormone and parathyroid hormone type-1 receptor accelerate myocyte differentiation |journal=Sci Rep |volume=4 |issue= |pages=5066 |year=2014 |pmid=24919035 |pmc=4052750 |doi=10.1038/srep05066 |url=}}</ref> | ||
==References== | ==References== | ||
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{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Disease]] | |||
[[Category:Medicine]] | |||
[[Category:Endocrinology]] | |||
[[Category:Parathyroid disorders]] | |||
[[Category:Up-To-Date]] | |||
Latest revision as of 22:18, 29 July 2020
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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.