SAT-342 Humerus Fracture & Dislocation of Right Shoulder Following a Seizure in Non-Epileptic Patient Due to Hypoparathyroidism

Abstract

Introduction: Hypoparathyroidism is a rare disease. The most common etiology of hypoparathyroidism is the surgical resection of the parathyroids.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.Parathyroid Hormone (PTH) is one of the key regulators of the rate of bone remodeling. A reduction or absence of circulating PTH leads initially to a decrease in bone resorption then to a coupled reduction in bone formation. Case Presentation A 36-year-old male nurse in primary health care, not known to have any medical illness, presented to the emergency department with generalized tonic-clonic seizures associated with right shoulder dislocation and communicated fracture of the humerus. However, the day before his presentation, he has had two episodes of convulsion, but he did not seek medical attention.He had developmental delay in walking and teeth eruption as well as frequent generalized tonic-clonic which were treated by traditional healer. This information could point out to the possibility of congenital origin.Upon arrival to the emergency department, he has teeth decay all over his oral cavity with right shoulder dislocation and right humerus fracture. Chvostek sign and trousseau sign were positive.The patient was treated initially with calcium gluconate intravenously followed by oral treatment of calcium carbonate 1.2 g three times daily and alfacalcidiol 1 mcg twice daily and upon discharge teriparatide 20 mcg subcutaneously daily was given.ConclusionTreatment of hypoparathyroidism with recombinant parathyroid hormone may reduce bone mineral density (BMD) but concomitantly strengthen bone.This is a treatable disorder that may have catastrophic results if overlooked but also its symptoms may be completely reversed with prompt treatment.It is of utmost importance routine vitamin D, phosphorous, and calcium monitoring, as well as renal calcium excretion evaluation to prevent complications of overtreatment with CA and active Vit D.References• Bilezikian JP, Khan A, Potts JT Jr, Brandi ML, Clarke BL, Shoback D, et al. Hypoparathyroidism in the adult: epidemiology, diagnosis, pathophysiology, target- organ involvement, treatment, and challenges for future research. J Bone Miner Res. 2011;26(10):2317-37.