hypoparathyroidism basic

1. -sinthu sarathamani

2. Hypoparathyroidism is
decreased function of
the parathyroid
DEFINITION
glands with
underproduction
of parathyroid hormone

4. calcium phosphorous

5. absence of a pair of
chromosome 22
Etiology unknown; sporadic
(nonhereditary); onset before age
20 years; external
ophthalmoplegia; complete heart
block.

6. Increased neuromuscular irritability
Including:
• Paresthesias (lips, tongue, fingers, feet)
• Muscle cramps
• Weakness
• Headaches
• Carpopedal spasms

7. Acute presentation may include:
• Tetany
• Seizures
• Altered mental state
• Congestive heart failure
• Stridor

8. Symptoms of longstanding
hypoparathyroidism include:
Cataracts
Malformations of teeth
Intracranial calcifications
Renal stones
Renal failure

9. SYMPTOMS
FROM
HEAD TO
FOOT

10. DIAGNOSTIC
SIGNS
Chvostek’s
Trousseau’s signs

11. Chvostek’s sign
An abnormal reaction to the
stimulation of the facial nerve.
When the facial nerve is
tapped at the angle of the jaw
(i.e. masseter muscle), the
facial muscles on the same
side of the face will contract
momentarily (typically a twitch
of the nose or lips) because
of hypocalcemia

12. To elicit the sign, a blood pressure
cuff is placed around the arm and
inflated to a pressure greater than
the systolic blood pressure and
held in place for 3 minutes. This will
occlude the brachial artery. In the
absence of blood flow, the patient's
hypocalcemia and subsequent
neuromuscular irritability will
induce spasm of the muscles of the
hand and forearm. The wrist
and metacarpophalangeal
jointsflex, the DIP and PIPjoints
extend, and the fingers adduct

13. Investigations

15. • Primary
• hypoparathyroidism
PTH
ca
• Secondary
hypoparathyroidism
PTH
ca
• Serum
• PTH and ca
levels

16. Measurement of 25-hydroxy vitamin D
• to exclude vitamin D deficiency as a cause of
hypocalcemia.
Serum magnesium
• Hypomagnesemia may cause PTH deficiency and
subsequent hypocalcemia
Serum phosphorus
• PTH is a phosphaturic hormone. In its absence,
phosphorus levels in the blood rise.

17. Medication
Surgical Care
Consultations
Diet

18. MEDICATION
Calcium salts and vitamin D are the
mainstays of treatment.
CALCIUM SALTS:
Calcium carbonate
Calcium citrate
Calcium gluconate
Vitamin D preparations
Ergocalciferol
Dihydrotachysterol
Calcifediol
Calcitriol

19. SURGICAL CARE
• Patients undergoing parathyroidectomy for parathyroid hyperplasia are
at high risk of developing permanent primary hypoparathyroidism.
• Patients may be treated with an autotransplant of a segment of
parathyroid gland to prevent hypoparathyroidism.[5] This
autotransplant is usually placed subcutaneously in the forearm or in the
neck.
• If the autotransplantation fails, patients receive the same treatment that
is administered to other patients with hypoparathyroidism.

20. Consultations
An
endocrinologist
should be involved
in the care of all
patients who have
primary
hypoparathyroidis
m or who are at
risk of developing
it
Diet
A diet rich in
calcium content
(ie, emphasizing
dairy products)
is
recommended
for patients
with primary
hypoparathyroi
dism.

21. “What is success? It is being able
to go to bed each night with your
soul at peace”
-Paulo coelho

22. THANK YOU