Hypoparathyroidism and elevated muscle enzymes

Shane, Elizabeth; McClane, Kenneth A.; Olarte, Marcelo R.; Bilezikian, John P.

doi:10.1212/wnl.30.2.192

Cited by 33 publications

(16 citation statements)

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“…Virtually all previous analogous publications represent cases of IHP [1][2][3][4][5]7,8,12 . In one case with osteomalacia, myopathy and hypocalcaemia, increased CK and alkaline phosphatase values were noted 13 , but this is not a consistent finding in the literature.…”

Section: Discussionmentioning

confidence: 99%

Hypoparathyroidism in a patient presenting with severe myopathy and skin rash. Case report and review of the literature

Syriou¹,

Kolitsa²,

Pantazi³

et al. 2005

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Section: Discussionmentioning

confidence: 99%

Hypoparathyroidism in a patient presenting with severe myopathy and skin rash. Case report and review of the literature

Syriou¹,

Kolitsa²,

Pantazi³

et al. 2005

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“…It has been proposed that it could be due to tetany, but there are reports of enzyme elevations unrelated to its occurrence 4,12 . Our patient, for example, had elevated CK levels with no evidence of tetany, and his Trousseau's and Chvostek's signs were negative.…”

Section: Discussionmentioning

confidence: 99%

Hypocalcemic myopathy without tetany due to idiopathic hypoparathyroidism: case report

Nora

Fricke

Becker

et al. 2004

Arq. Neuro-Psiquiatr.

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-Myopathy due to idiopathic hypoparathyroidism is very unusual. We report on a 30 years-old man referred with complaints of sporadic muscle pain and mild global weakness for 10 years. His physical examination showed normal strength in distal muscle and slightly weakness in the pelvic and scapular girdles with no atrophy. Deep muscle reflexes were slightly hypoactive. Trousseau's and Chvostek's signs were absent. He had bilateral cataract and complex partial seizures. His laboratory tests showed decreased ionised and total calcium and parathyroid hormone and increased muscle enzymes. EMG and muscle biopsy was compatible with metabolic myopathy. After treatment with calcium and vitamin D supplementation he showed clinical, neurophisiological and laboratorial improvement. In conclusion: patients with muscle symptoms, even when non-specific and with normal neurological examination, should have serum calcium checked, as myopathy due to idiopathic hypoparathyroidism, even being rare, is treatable and easy to diagnose.KEY WORDS: myopathy, hypocalcemia, hypoparathyroidism. Miopatia hipocalcêmica secundária a hipoparatireiodismo idiopático sem tetamia: relato de casoRESUMO -Miopatia secundária a hipoparatireidismo idiopático é enfermidade raramente descrita. Relatamos o caso de homem de 30 anos que procurou atendimento médico com queixas de dores musculares e discreta fraqueza há cerca de 10 anos. Ao exame físico apresentava leve diminuição de força na musculatura pélvica e escapular, sem atrofia, ou fraqueza distal. Os reflexos miotáticos fásicos eram hipoativos e não havia sinais de Trousseau ou Chevostek. Havia história de catarata bilateral e crises parciais complexas. Os exames laboratoriais demonstraram hipocalcemia, com diminuição do paratormônio, hiperfosfatemia e enzimas musculares elevadas. A EMG e a biópsia de músculo foram compatíveis com miopatia metabóli-ca. Após reposição de cálcio e vitamina D houve melhora clínica e neurofisiológica. Em conclusão: em pacientes com sintomas musculares, mesmo não específicos para miopatia ou com exame neurológico normal, devese dosar cálcio sérico, já que miopatia associada a hipoparatireoidismo é uma doença facilmente diagnosticada e tratável. PALAVRAS-CHAVE: miopatia, hipocalcemia, hipoparatireoidismo.Myopathy due to idiopathic hypoparathyroidism (IHP) is an extremely rare condition, with little more than 10 cases described in the literature, and its pathophysiology is not well established [1][2][3][4] . IHP is an infrequent disease of unknown aetiology, caused by insufficient secretion of parathyroid hormone (PTH). Its estimated prevalence in Japan is 7.2 cases per million individuals 5 . The reduced secretion of this hormone leads to hypocalcemia and hyperphosphatemia, due to the inhibition in calcium reabsorption in distal tubules and bone matrix, and also to the deficiency in the synthesis of 1,25-dihydroxyvitamin D. The clinical manifestations of IHP are multiple and affect mainly tissues of ectodermic origin. Among the most common findings in these patient...

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“…Levels of serum lactate dehydrogenase (LDH ; 977 IU/100 ml) and creatine phosphokinase (CPK ; 381 IU/100 ml) were increased. (These phenomena are reported to be caused by hypoparathyroidism (Shane et al 1980)). Serum PTH was undetectable.…”

Section: Report Of a Casementioning

confidence: 99%

Paroxysmal kinesigenic choreoathetosis and paroxysmal dystonic choreoathetosis in a patient with familial idiopathic hypoparathyroidism.

Kato

Kobayashi

Kohari

et al. 1987

Tohoku J. Exp. Med.

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A patient with familial idiopathic hypoparathyroidism whose major symptoms were paroxysmal kinesigenic choreoathetosis (PKC) and paroxysmal dystonic choreoathetosis (PDC) was reported. CT revealed marked calcification in the basal ganglia, the thalamus and the dentate nucleus of cerebellum. Positron emission tomographic (PET) study showed decreased glucose metabolism in the basal ganglia and thalamus. The paroxysms were eliminated by the normalization of serum calcium level. Thus the paroxysms seemed to be induced by hypocalcemia which stimulated the lesions in the basal ganglia and thalamus, on one occasion, as in PKC, and on the other occasion, as in PDC. Concomitant occurrence of both PKC and PDC in a patient is unique and is of interest in considering the pathomechanisms of these different but related disorders.paroxysmal kinesigenic choreoathetosis (PKC) ; paroxysmal dystonic choreoathetosis (PDC) ; familial idiopathic hypoparathyroidism Idiopathic hypoparathyroidism is a rare disorder often presenting neurological symptoms including epileptic seizures, tetany, sensory disturbances, cerebellar and extrapyramidal signs (Simpson 1952). Paroxysmal choreoathetosis, on the other hand, is also a rare disorder of which pathological mechanisms are poorly understood (Lance 1977). It has been divided into two types, paroxysmal kinesigenic choreoathetosis (PKC) (Kertesz 1967;Plant 1983) and paroxysmal dystonic choreoathetosis (PDC) (Mount and Reback 1940;Richards and Barnett 1968;Lance 1977). We had the opportunity to study a young woman with familial idiopathic hypoparathyroidism in which major symptoms were concomitant PKC and PDC. Thus far, it has been emphasized that PKC and PDC are different clinical entities. Our case is of interest because concomitant occurrence of both PKC and PDC is not known. Possible mechanisms of the secondary paroxysmal choreoathetoses in this patient is discussed.

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Hypoparathyroidism and elevated muscle enzymes

Cited by 33 publications

References 0 publications

Hypoparathyroidism in a patient presenting with severe myopathy and skin rash. Case report and review of the literature

Hypoparathyroidism in a patient presenting with severe myopathy and skin rash. Case report and review of the literature

Hypocalcemic myopathy without tetany due to idiopathic hypoparathyroidism: case report

Paroxysmal kinesigenic choreoathetosis and paroxysmal dystonic choreoathetosis in a patient with familial idiopathic hypoparathyroidism.

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