Hypoparathyroidism physical examination: Difference between revisions
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{{Hypoparathyroidism}} | {{Hypoparathyroidism}} | ||
{{CMG}}; {{AE}} {{Anmol}} | |||
==Overview== | |||
Physical examination of patients with hypoparathyroidism is usually due to [[hypocalcemia]]. The presence of [[tetany]] on physical examination is diagnostic of [[hypocalcemia]] which is commonly caused by hypoparathyroidism. The presence of [[Chvostek's sign]] and [[Trousseau's sign|Trousseau's sign]] on physical examination is highly suggestive of [[hypocalcemia]] which is commonly caused by hypoparathyroidism. | |||
==Physical Examination== | |||
*Physical examination of patients with hypoparathyroidism is usually due to [[hypocalcemia]].<ref name="pmid28138323">{{cite journal |vauthors=Abate EG, Clarke BL |title=Review of Hypoparathyroidism |journal=Front Endocrinol (Lausanne) |volume=7 |issue= |pages=172 |year=2016 |pmid=28138323 |pmc=5237638 |doi=10.3389/fendo.2016.00172 |url=}}</ref><ref name="pmid18535072">{{cite journal |vauthors=Cooper MS, Gittoes NJ |title=Diagnosis and management of hypocalcaemia |journal=BMJ |volume=336 |issue=7656 |pages=1298–302 |year=2008 |pmid=18535072 |pmc=2413335 |doi=10.1136/bmj.39582.589433.BE |url=}}</ref> | |||
*The presence of [[tetany]] on physical examination is diagnostic of [[hypocalcemia]] which is commonly caused by hypoparathyroidism.<ref>{{cite book |last1=Schafer |first1=AL |last2=Shoback |first2=DM |editor-last1=De Groot |editor-first1=LJ |editor-last2=Chrousos |editor-first2=G |editor-last3=Dungan |editor-first3=K |display-editors=etal |date= |title=Hypocalcemia: Diagnosis and Treatment. [Updated 2016 Jan 3]. |url=https://www.ncbi.nlm.nih.gov/books/NBK279022/ |location= Endotext [Internet]. |publisher=South Dartmouth (MA): MDText.com, Inc.; 2000-. |page= |isbn= |author-link= }}</ref> | |||
*The presence of [[Chvostek's sign]] and [[Trousseau's sign|Trousseau's sign]] on physical examination is highly suggestive of [[hypocalcemia]] which is commonly caused by hypoparathyroidism.<ref name="pmid18650515">{{cite journal |vauthors=Shoback D |title=Clinical practice. Hypoparathyroidism |journal=N. Engl. J. Med. |volume=359 |issue=4 |pages=391–403 |year=2008 |pmid=18650515 |doi=10.1056/NEJMcp0803050 |url=}}</ref> | |||
===Appearance of the Patient=== | |||
*Patients with hypoparathyroidism usually have [[neuromuscular]] [[irritability]] and may appear [[dysphoric]]. | |||
===Vital Signs=== | |||
Some patient may have: | |||
*[[Bradycardia]] | |||
===Skin=== | |||
Careful examination of [[skin]] around [[neck]] should be done for [[surgical]] scar. | |||
Common signs present are: | |||
*[[Dry skin]] | |||
*Coarse [[hair]] | |||
*[[Brittle nails]] | |||
*[[Alopecia]] (patchy) | |||
Some patient may have: | |||
*[[Vitiligo]] | |||
===HEENT=== | |||
Some patients may have: | |||
*Subcapsular [[cataracts]] | |||
*[[Papilledema]]<ref name="pmid3690435">{{cite journal |vauthors=Sheldon RS, Becker WJ, Hanley DA, Culver RL |title=Hypoparathyroidism and pseudotumor cerebri: an infrequent clinical association |journal=Can J Neurol Sci |volume=14 |issue=4 |pages=622–5 |year=1987 |pmid=3690435 |doi= |url=}}</ref> | |||
===Dental signs=== | |||
Some pediatric patients may have: | |||
*[[Enamel]] [[hypoplasia]] | |||
*Shortened [[premolar]] roots | |||
*Thickened lamina dura | |||
*Delayed tooth eruption | |||
*[[Dental caries]] | |||
===Lungs=== | |||
Some patients may have: | |||
*[[Dyspnea]] | |||
*[[Wheeze|Wheezing]] | |||
===Heart=== | |||
Some patients may have: | |||
*[[Palpitation]] | |||
*Signs of [[congestive heart failure]] such as [[fluid overload]] ([[S3 gallop]])<ref name="pmid4014262">{{cite journal |vauthors=Levine SN, Rheams CN |title=Hypocalcemic heart failure |journal=Am. J. Med. |volume=78 |issue=6 Pt 1 |pages=1033–5 |year=1985 |pmid=4014262 |doi= |url=}}</ref> | |||
* Signs of [[cardiomyopathy]]<ref name="pmid1633370">{{cite journal |vauthors=Kudoh C, Tanaka S, Marusaki S, Takahashi N, Miyazaki Y, Yoshioka N, Hayashi M, Shimamoto K, Kikuchi K, Iimura O |title=Hypocalcemic cardiomyopathy in a patient with idiopathic hypoparathyroidism |journal=Intern. Med. |volume=31 |issue=4 |pages=561–8 |year=1992 |pmid=1633370 |doi= |url=}}</ref> | |||
===Abdomen=== | |||
Some patients may have: | |||
* [[Dysphagia]] | |||
===Neuromuscular=== | |||
Most common presentation is due to neuromuscular irritability. It present as: | |||
*[[Tetany|'''Tetany''']] | |||
*'''[[Chvostek's sign]]:''' [[Facial twitching]], especially around the [[mouth]]. It is elicited by tapping the [[cheek]] (2 cm anterior to the earlobe below the [[zygomatic process]]) over the path of the [[facial nerve]]. Ipsilateral [[twitching]] of the upper [[lip]] is considered as positive sign. | |||
*'''[[Trousseau's sign]]:''' Painful carpal spasm. It is elicited by inflating a [[blood pressure]] cuff around the arm to a pressure 20 mm Hg above obliteration of the [[radial pulse]] for 3-5 minutes. | |||
*[[Tingling]], burning, and/or [[numbness]] in the [[Fingertip|fingertips]], [[Toe|toes]] and [[lips]] | |||
*[[Muscle weakness]] | |||
*Signs of [[increased intracranial pressure]] | |||
*[[Dystonic]] [[spasms]] | |||
Some patients may have: | |||
*[[Intellectual disability]] | |||
*[[Confusion]] | |||
*[[Disorientation]] | |||
Some patients may have [[extrapyramidal]] signs (due to [[calcification]] of [[basal ganglia]]):<ref name="pmid22224190">{{cite journal |vauthors=Basak RC |title=A case report of Basal Ganglia calcification - a rare finding of hypoparathyroidism |journal=Oman Med J |volume=24 |issue=3 |pages=220–2 |year=2009 |pmid=22224190 |pmc=3251182 |doi=10.5001/omj.2009.44 |url=}}</ref> | |||
*[[Parkinsonism]] | |||
*[[Choreoathetosis]] | |||
*[[Dystonia]] | |||
*[[Oculogyric crisis]] | |||
*[[Hemiballismus]] | |||
===Psychiatric=== | |||
Some patients may have psychiatric manifestations:<ref name="pmid11834431">{{cite journal |vauthors=Arlt W, Fremerey C, Callies F, Reincke M, Schneider P, Timmermann W, Allolio B |title=Well-being, mood and calcium homeostasis in patients with hypoparathyroidism receiving standard treatment with calcium and vitamin D |journal=Eur. J. Endocrinol. |volume=146 |issue=2 |pages=215–22 |year=2002 |pmid=11834431 |doi= |url=}}</ref><ref name="pmid25772947">{{cite journal |vauthors=Lin KF, Chen KH, Huang WL |title=Organic anxiety in a woman with breast cancer receiving denosumab |journal=Gen Hosp Psychiatry |volume=37 |issue=2 |pages=192.e7–8 |year=2015 |pmid=25772947 |doi=10.1016/j.genhosppsych.2015.01.007 |url=}}</ref> | |||
*[[Anxiety]] | |||
*[[Depression]] | |||
*[[Irritability]] | |||
*[[Psychosis]] | |||
*[[Anxiety]] | |||
*Memory disturbances | |||
*Reduced concentration | |||
===Extremities=== | |||
Some patients may have: | |||
*[[Edema]] due to [[cardiac dysfunction]] | |||
==References== | ==References== | ||
{{Reflist|2}} | |||
{{ | {{WH}} | ||
[[Category: | {{WS}} | ||
[[Category:Disease]] | |||
[[Category:Medicine]] | |||
[[Category:Endocrinology]] | |||
[[Category:Parathyroid disorders]] | [[Category:Parathyroid disorders]] | ||
[[Category: | [[Category:Up-To-Date]] | ||
Latest revision as of 22:18, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2]
Overview
Physical examination of patients with hypoparathyroidism is usually due to hypocalcemia. The presence of tetany on physical examination is diagnostic of hypocalcemia which is commonly caused by hypoparathyroidism. The presence of Chvostek's sign and Trousseau's sign on physical examination is highly suggestive of hypocalcemia which is commonly caused by hypoparathyroidism.
Physical Examination
- Physical examination of patients with hypoparathyroidism is usually due to hypocalcemia.[1][2]
- The presence of tetany on physical examination is diagnostic of hypocalcemia which is commonly caused by hypoparathyroidism.[3]
- The presence of Chvostek's sign and Trousseau's sign on physical examination is highly suggestive of hypocalcemia which is commonly caused by hypoparathyroidism.[4]
Appearance of the Patient
- Patients with hypoparathyroidism usually have neuromuscular irritability and may appear dysphoric.
Vital Signs
Some patient may have:
Skin
Careful examination of skin around neck should be done for surgical scar.
Common signs present are:
- Dry skin
- Coarse hair
- Brittle nails
- Alopecia (patchy)
Some patient may have:
HEENT
Some patients may have:
- Subcapsular cataracts
- Papilledema[5]
Dental signs
Some pediatric patients may have:
- Enamel hypoplasia
- Shortened premolar roots
- Thickened lamina dura
- Delayed tooth eruption
- Dental caries
Lungs
Some patients may have:
Heart
Some patients may have:
- Palpitation
- Signs of congestive heart failure such as fluid overload (S3 gallop)[6]
- Signs of cardiomyopathy[7]
Abdomen
Some patients may have:
Neuromuscular
Most common presentation is due to neuromuscular irritability. It present as:
- Tetany
- Chvostek's sign: Facial twitching, especially around the mouth. It is elicited by tapping the cheek (2 cm anterior to the earlobe below the zygomatic process) over the path of the facial nerve. Ipsilateral twitching of the upper lip is considered as positive sign.
- Trousseau's sign: Painful carpal spasm. It is elicited by inflating a blood pressure cuff around the arm to a pressure 20 mm Hg above obliteration of the radial pulse for 3-5 minutes.
- Tingling, burning, and/or numbness in the fingertips, toes and lips
- Muscle weakness
- Signs of increased intracranial pressure
- Dystonic spasms
Some patients may have:
Some patients may have extrapyramidal signs (due to calcification of basal ganglia):[8]
Psychiatric
Some patients may have psychiatric manifestations:[9][10]
- Anxiety
- Depression
- Irritability
- Psychosis
- Anxiety
- Memory disturbances
- Reduced concentration
Extremities
Some patients may have:
- Edema due to cardiac dysfunction
References
- ↑ Abate EG, Clarke BL (2016). "Review of Hypoparathyroidism". Front Endocrinol (Lausanne). 7: 172. doi:10.3389/fendo.2016.00172. PMC 5237638. PMID 28138323.
- ↑ Cooper MS, Gittoes NJ (2008). "Diagnosis and management of hypocalcaemia". BMJ. 336 (7656): 1298–302. doi:10.1136/bmj.39582.589433.BE. PMC 2413335. PMID 18535072.
- ↑ Schafer, AL; Shoback, DM. De Groot, LJ; Chrousos, G; Dungan, K; et al., eds. Hypocalcemia: Diagnosis and Treatment. [Updated 2016 Jan 3]. Endotext [Internet].: South Dartmouth (MA): MDText.com, Inc.; 2000-.
- ↑ Shoback D (2008). "Clinical practice. Hypoparathyroidism". N. Engl. J. Med. 359 (4): 391–403. doi:10.1056/NEJMcp0803050. PMID 18650515.
- ↑ Sheldon RS, Becker WJ, Hanley DA, Culver RL (1987). "Hypoparathyroidism and pseudotumor cerebri: an infrequent clinical association". Can J Neurol Sci. 14 (4): 622–5. PMID 3690435.
- ↑ Levine SN, Rheams CN (1985). "Hypocalcemic heart failure". Am. J. Med. 78 (6 Pt 1): 1033–5. PMID 4014262.
- ↑ Kudoh C, Tanaka S, Marusaki S, Takahashi N, Miyazaki Y, Yoshioka N, Hayashi M, Shimamoto K, Kikuchi K, Iimura O (1992). "Hypocalcemic cardiomyopathy in a patient with idiopathic hypoparathyroidism". Intern. Med. 31 (4): 561–8. PMID 1633370.
- ↑ Basak RC (2009). "A case report of Basal Ganglia calcification - a rare finding of hypoparathyroidism". Oman Med J. 24 (3): 220–2. doi:10.5001/omj.2009.44. PMC 3251182. PMID 22224190.
- ↑ Arlt W, Fremerey C, Callies F, Reincke M, Schneider P, Timmermann W, Allolio B (2002). "Well-being, mood and calcium homeostasis in patients with hypoparathyroidism receiving standard treatment with calcium and vitamin D". Eur. J. Endocrinol. 146 (2): 215–22. PMID 11834431.
- ↑ Lin KF, Chen KH, Huang WL (2015). "Organic anxiety in a woman with breast cancer receiving denosumab". Gen Hosp Psychiatry. 37 (2): 192.e7–8. doi:10.1016/j.genhosppsych.2015.01.007. PMID 25772947.