A Case of Primary Hypoparathyroidism Presenting with Acute Kidney Injury Secondary to Rhabdomyolysis.

Abdullah Sumnu,Meltem Gursu,Zeki Aydin,Savas Ozturk,Egemen Cebeci,Serhat Karadag,Rumeyza Kazancioglu,Sami Uzun

doi:10.1155/2016/3240131

Abstract

Hypoparathyroidism is the most common cause of symmetric calcification of the basal ganglia. Herein, a case of primary hypoparathyroidism with severe tetany, rhabdomyolysis, and acute kidney injury is presented. A 26-year-old male was admitted to the emergency clinic with leg pain and cramps, nausea, vomiting, and decreased amount of urine. He had been treated for epilepsy for the last 10 years. He was admitted to the emergency department for leg pain, cramping in the hands and legs, and agitation multiple times within the last six months. He was prescribed antidepressant and antipsychotic medications. He had a blood pressure of 150/90 mmHg, diffuse abdominal tenderness, and abdominal muscle rigidity on physical examination. Pathological laboratory findings were as follows: creatinine, 7.5 mg/dL, calcium, 3.7 mg/dL, alanine transaminase, 4349 U/L, aspartate transaminase, 5237 U/L, creatine phosphokinase, 262.000 U/L, and parathyroid hormone, 0 pg/mL. There were bilateral symmetrical calcifications in basal ganglia and the cerebellum on computerized tomography. He was diagnosed as primary hypoparathyroidism and acute kidney injury secondary to severe rhabdomyolysis. Brain calcifications, although rare, should be considered in dealing with patients with neurological symptoms, symmetrical cranial calcifications, and calcium metabolism abnormalities.

Highlights

Symmetric calcification of the basal ganglia identified radiographically occurs in a variety of familial and nonfamilial conditions
Primary Familial Brain Calcifications (PFBC), which were known by many names previously, including Fahr disease and striopallidodentate calcinosis, are a genetic disease characterized by various mutations in four separate genes and autosomal dominant inheritance [1,2,3,4]
There were bilateral symmetrical calcifications in basal ganglia and the cerebellum on cranial CT (Figure 1). He was diagnosed as primary hypoparathyroidism and acute kidney injury (AKI) secondary to rhabdomyolysis

Summary

Introduction

Symmetric calcification of the basal ganglia identified radiographically occurs in a variety of familial and nonfamilial conditions. Many secondary causes, either infectious, toxic, or metabolic, have been described to cause symmetrical basal ganglion calcifications and so are in the differential diagnosis of PFBC [6]. Parathyroid diseases such as hypoparathyroidism, pseudohypoparathyroidism, and pseudo-pseudohypoparathyroidism are in the forefront among the metabolic causes. A twenty-six-year-old male was admitted to the emergency clinic with pain and cramps in the legs, nausea, vomiting, and a decrease in the amount of urine He had a head trauma due to a fall from a height 15 years ago requiring treatment for 45 days in the intensive care unit and had been treated for epilepsy for the last 10 years.

Result at discharge

Discussion