POS-094 A CASE OF HYPOPARATHYROIDISM: WHEN A NEPHROLOGIST TURNS INTO AN ENDOCRINOLOGIST

Abstract

Hypoparathyroidism is a rare endocrine disorder infrequently seen in everyday practice. It may be primary due to a genetic cause or secondary which is by far the most common form and due to a variety of etiologies for instance during radiation, auto-immune diseases or acquired after neck surgery with the latter being the most common cause accounting for 75 % of cases. Herein we report the case of a patient who presented to our department as a potential kidney donor to her husband. The pre-transplant workup has shown features of hypoparathyroidism that were subsequently confirmed. The patient is a 36-year-old female with no past medical history of auto-immune disease and no history of neck surgery. She denies any over the counter consumption of dietary or supplemental intake of calcium or vitamin D. She also denied any family history of hypoparathyroidism or consanguinity thus ruling out a genetic cause and no history of autoimmune disease or other endocrine disorders. She had dry scaly skin, thin hair, and fragile nails. No mucocutaneous candidiasis. No scars of previous trauma or surgery in the neck. No malar rash. A carpal spasm was observed during the inflation of the blood pressure cuff on the arm classically know as The Trousseau sign. An ophthalmology exam has shown a cataract at an early onset. An electrocardiogram has shown a slightly prolonged QT interval. A laboratory exam was performed. Her creatinine was normal at 62 uoml/l. She had hypocalcemia of 1.35 mmol/l, a phosphatemia of 1.7 mmol/l, a normal magnesium level of 0.8mmol/l, a PTH level of 12 pg/ml, vitamin D was 18.1 ng/ml. Additional workup was performed seeking other endocrine disorders that may be associated. For instance, her thyroid-stimulating hormone was normal at 2.98 UI/ml with a normal level of free thyroxin at 13.3 ng/ml. Her cortisol level was slightly low at 84 ug/l compared to the laboratory inferior normal limit of 100 but she did not exhibit any signs of adrenal insufficiency. Ultrasonography did not show any kidney stones or abnormalities. A cerebral scan was also performed looking for basal ganglia calcifications and luckily came back normal. An immunologic assessment was performed including antinuclear antibodies, anti-thyroid peroxidase antibodies, anti-thyroglobulin antibodies and came back negative The patient was treated with IV supplementation of calcium in the acute phase in order to alleviate the cardiovascular signs seen in the electrocardiogram. She was then supplemented with oral calcium and vitamin D. Her calcium levels were at 1.9 mmol/l. Her symptoms improved at discharge. Hypoparathyroidism is a rare endocrine disorder. A thorough work-up should be done to look for a cause. It may be due to a variety of etiologies but so far neck surgery represents 75 % of cases.