Primary hypoparathyroidism presenting as basal ganglia calcification secondary to extreme hypocalcemia.

Edite Marques Mendes,Carla Meira,Diana Guerra,Lúcia Meireles-Brandão,Nuno Morais,Carlos Ribeiro

doi:10.4081/cp.2018.1007

Edite Marques Mendes, Carla Meira + Show 4 more

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https://doi.org/10.4081/cp.2018.1007

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Abstract

Hypoparathyroidism is a rare endocrine disorder characterized by low serum calcium and parathyroid hormone levels. The most common cause is parathyroid iatrogenic surgical removal. However, innumerous and rarer conditions can cause hypoparathyroidism. The authors describe a 27-year-old man that presented in emergency department with confusion, amnesia and decreased attention span. A cerebral computed tomography revealed bilateral extensive calcification in the basal ganglia. A complete work-up revealed low serum calcium, high serum phosphorus and low parathyroid hormone, leading to the diagnosis of idiopathic primary hypoparathyroidism. Initial intravenous therapy with calcium gluconate and calcitriol was administered, with clinical and analytical improvement. The authors describe a rare condition, with an exuberant cerebral presentation and extreme hypocalcemia, which did not directly correlate to the severity of symptoms. Not only this is a treatable disorder that may have catastrophic results if overlooked but also its symptoms may be completely reversed with prompt treatment.

Highlights

Globus pallidus) and the caudate nuclei of the basal ganglia
Primary hypoparathyroidism can cause a wide spectrum of manifestations, mainly due to low serum calcium effect on internal organs, and directly correlates with the rate of development of hypocalcemia
Primary hypoparathyroidism is a rare department due to memory impairment and orientation, with no focal deficits or endocrine disorder characterized by decreased attention span with onset early meningism

Summary

Introduction

Globus pallidus) and the caudate nuclei of the basal ganglia. Other organs can be affected, more frequently kidneys (presenting as nephrolithiasis or nephrocalcinosis), but can be seen in joints, eyes (cataract), skin, vasculature, and other organ systems.[4,5] Primary hypoparathyroidism can cause a wide spectrum of manifestations, mainly due to low serum calcium effect on internal organs, and directly correlates with the rate of development of hypocalcemia. In this case a rare condition was diagnosed and it presented exuberant cerebral involvement with extreme hypocalcemia that did not directly correlate to the severity of symptoms.

Results

Conclusion