Hypoparathyroidism physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2]
Overview
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
OR
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
OR
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
Physical Examination
- Physical examination of patients with hypoparathyroidis 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 dysphoretic.
Skin
Common signs are:
- Careful examination of skin around neck should be done for surgical scar.
- Dry skin
- Coarse hair
- Brittle nails
- Alopecia (patchy)
Some patient may have:
- Atopic eczema
- Vitiligo
- Exfoliative dermatitis
- Psoriasis
- Impetigo herpetiformis
HEENT
Some patients may have:
- Subcapsular cataracts
- Papilledema[5]
Dental signs
- Enamel hypoplasia
- Shortened premolar roots
- Thickened lamina dura
- Delayed tooth eruption
- Increased dental caries
Lungs
- Dyspnea
- Wheezing
Heart
- Signs of congestive heart failure such as fluid overload (S3 sound)[6]
Signs of cardiomyopathy[7]
Abdomen
Dysphagia
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, or numbness in the fingertips, toes and lips.
- Muscle weakness
- Signs of increased intracrania pressure
- Dystonic spasms
Some patients may have:
- Impaired intellectual ability
- Confusion
- Disorientation
Some patients may have extrapyramidal signs (due to calcification of basal ganglia):[8]
- Parkinsonism
- Choreoathetosis
- Dystonia
- Oculogyric crisis
- Hemiballasmus
Psychological
Some patients may have psychiatric manifestations:[9][10]
- Anxiety
- Depression
- Irritability
- Psychosis
- Anxiety
- Poor memory
- Reduced concentration
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.