Hypoparathyroidism Presenting as Recurring Muscle Aches and Grossly Elevated Serum Creatine Kinase

Abstract

Idiopathic hypoparathyroidism rarely manifests with myopathy. Serum calcium in patients with unexplained myalgia and/or muscle weakness must be measured to rule out hypoparathyroidism since the body being adapted to long-standing hypocalcaemia gives very few or non-specific symptoms and the diagnosis can be easily missed. We here present case of 36 year old Indian male with muscle spasms of bilateral upper limbs of seven days duration having past history of 4 years of distal paresthesias and recurring muscle aches and fatigability. On investigation the patient had an elevated serum creatine kinase. On further evaluation, the diagnosis of myopathy due to idiopathic hypoparathyroidism was made. He was treated with oral calcium and calcitriol and showed dramatic improvement. This case exemplifies the subtle nature of hypoparathyroid myopathy and highlights the importance of measuring serum calcium in patients with unexplained myalgia and/or muscle weakness.