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==Signs and symptoms==
[[Hypocalcemia]] is the only real result of parathyroid dysfunction and low PTH levels. This presents with [[tremor]], [[tetany]] and, eventually, [[convulsion]]s.
In contrast to [[hyperparathyroidism]] (hyperfunction of the parathyroids), hypoparathyroidism does not have consequences for [[bone]].
==Diagnosis==
Diagnosis is by measurement of [[calcium]], [[serum albumin]] (for correction) and [[PTH]] in [[blood test|blood]]. [[PTH]] degrades rapidly at ambient temperatures and the blood sample therefore has to be transported to the laboratory on ice.
If necessary, measuring [[Cyclic adenosine monophosphate|cAMP]] ([[cyclic AMP]]) in the urine after an intravenous dose of [[PTH]] can help in the distinction between [[hypoparathyroidism]] and other causes.
Differential diagnoses are:
* [[Pseudohypoparathyroidism]] (normal [[PTH]] levels but tissue insensitivity to the hormone, associated with [[mental retardation]] and [[skeleton|skeletal deformities]]) and [[pseudopseudohypoparathyroidism]] (''sic'').
* Deficiency of [[Vitamin D]] or hereditary insensitivity to this vitamin (X-linked dominant).
* [[Malabsorption]]
* [[Kidney disease]]
* Medication: [[steroid]]s, [[diuretic]]s, some [[antiepileptic]]s.
==Causes==
Hypoparathyroidism can have a number of divergent causes:
* Removal of the parathyroid glands in [[thyroid]] surgery ([[thyroidectomy]]) is a recognised cause. It is now uncommon, as [[surgery|surgeon]]s generally spare them during the procedure after identifying them.
* [[Autoimmune disorder|Autoimmune]] invasion and destruction is the most common non-surgical cause. It can occur as part of [[autoimmune polyendocrine syndrome]]s.
* [[Hemochromatosis]] can lead to iron accumulation and consequent dysfunction of a number of endocrine organs, including the parathyroids.
* Absence or dysfunction of the parathyroid glands is one of the components of [[Chromosome 22, microdeletion 22 q11|chromosome 22q11 microdeletion syndrome]] (other names: DiGeorge syndrome, Schprintzen syndrome, velocardiofacial syndrome).
* [[Magnesium]] deficiency
* Some very [[rare disease]]s
* Idiopathic (of unknown cause), occasionally familial
==Treatment==
Severe hypocalcemia, a potentially life-threatening condition,  is treated as soon as possible with [[intravenous]] [[calcium]] (e.g. as [[calcium gluconate]]). Generally, a central venous catheter is recommended, as the calcium can irritate [[peripheral vein]]s and cause [[phlebitis]].
Long-term treatment of hypoparathyroidism is with calcium and [[Vitamin D3]] supplementation (D1 is ineffective in the absence of renal conversion). [[Teriparatide]], a synthetic form of PTH (presently registered for [[osteoporosis]]) might become the treatment of choice for PTH supplementation, although further studies are awaited.


==Related Chapters==
==Related Chapters==

Revision as of 21:47, 20 September 2012

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Hypoparathyroidism
ICD-10 E20, E89.2, P71.4
ICD-9 252.1
DiseasesDB 6490
MeSH D007011

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


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