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

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.

Rhabdomyolysis in a Patient with Severe Hypothyroidism

“…There have been several case reports in which hypocalcemia has been considered as the possible cause of rhabdomyolysis, but the mechanism of hypocalcemia-induced rhabdomyolysis is not well understood [ 31 – 33 ]. In a case report by Akmal [ 31 ], he reports a case of rhabdomyolysis in a patient with hypoparathyroidism whose calcium was as low as 4.1 mg/dL.…”

“…In two other cases, reported by Hower et al [ 32 ], the calcium levels were also as low as 4.4 and 3.8 mg/dL. In another case of hypoparathyroidism presenting with rhabdomyolysis, reported by Sumnu et al, the serum calcium level was 3.7 mg/dL [ 33 ]. According to this review of the literature, the corrected calcium level of 6.5 mg/dL, as shown in our patient, was unlikely to have been the cause of rhabdomyolysis.…”

Non-traumatic and non-drug-induced rhabdomyolysis

“…Muscle involvement in hypoparathyroidism may present as myopathy, neuromyotonia, or RM. Sumnu et al [99] describe the case of a 26-yearold epileptic male with leg myalgias, cramps, nausea, vomiting, and decreased urine output. He was admitted to the emergency department several times over 6 months and eventually diagnosed with primary hypoparathyroidism and AKD secondary to severe RM.…”