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Pseudohypoparathyroidism

Last reviewed: 12 Apr 2025
Last updated: 10 Dec 2024

Summary

Definition

History and exam

Key diagnostic factors

  • positive family history of PHP
  • muscle cramp
  • paresthesias
  • muscle twitches
  • positive Chvostek sign
  • intellectual disability
  • Albright hereditary osteodystrophy
  • muscle spasm
  • tetany
  • positive Trousseau sign
Full details

Other diagnostic factors

  • lethargy
  • anxiety
  • seizures
  • paroxysmal dyskinesias
  • brittle nails
  • dry hair
  • subcutaneous calcification
  • cataracts
  • features of hypothyroidism
  • features of other hormone resistance
  • Chiari type 1 anomaly
  • history of cholesterol gallstones
  • features of psychosis
Full details

Risk factors

  • positive family history of PHP
Full details

Diagnostic tests

1st tests to order

  • serum calcium
  • serum phosphorus
  • serum PTH
  • serum creatinine
  • serum magnesium
  • serum 25-hydroxyvitamin D
  • follicle-stimulating hormone
  • luteinizing hormone
  • estradiol
  • testosterone
  • growth hormone
  • insulin-like growth factor-1
Full details

Tests to consider

  • x-ray hands
  • ECG
  • serum thyroid-stimulating hormone (TSH)
  • serum free thyroxine (T4)
  • response to exogenous human PTH(1-34)
  • dual-energy x-ray absorptiometry (DXA) bone-density scan
  • CT head
  • mutation analysis of GNAS
Full details

Treatment algorithm

ACUTE

symptomatic hypocalcemia

ONGOING

asymptomatic hypocalcemia

Contributors

Authors

Neil Gittoes, MD, FRCP

Consultant Endocrinologist and Honorary Professor of Endocrinology

Department of Endocrinology

Centre for Endocrinology, Diabetes and Metabolism

Queen Elizabeth Hospital Birmingham

Birmingham

UK

Disclosures

NG has contributed to advisory boards for Takeda and Shire pharmaceuticals.

John Ayuk, MD, FRCP

Consultant Endocrinologist

Department of Endocrinology

Queen Elizabeth Hospital Birmingham

Birmingham

UK

Disclosures

JA declares that he has no competing interests.

Acknowledgements

Professor Neil Gittoes and Dr John Ayuk would like to gratefully acknowledge Dr Emad Naem and Dr Kent Wehmeier, previous contributors to this topic.

Disclosures

EN and KW declare that they have no competing interests.

Peer reviewers

Giovanna Mantovani, MD

Institute of Endocrine Science

University of Milan

Milan

Italy

Disclosures

GM is an author of a number of references cited in this topic.

Ronald Merrell, MD

Professor of Surgery

Virginia Commonwealth University

Richmond

VA

Disclosures

RM declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Mantovani G, Bastepe M, Monk D, et al. Diagnosis and management of pseudohypoparathyroidism and related disorders: first international Consensus Statement. Nat Rev Endocrinol. 2018 Aug;14(8):476-500.Full text  Abstract

Mantovani G, Bastepe M, Monk D, et al. Recommendations for diagnosis and treatment of pseudohypoparathyroidism and related disorders: an updated practical tool for physicians and patients. Horm Res Paediatr. 2020;93(3):182-96.Full text  Abstract

American Society for Bone and Mineral Research. Primer on the metabolic bone diseases and disorders of mineral metabolism. 9th ed. 2018 [internet publication].Full text

Mantovani G, Spada A. Mutations in the Gs alpha gene causing hormone resistance. Best Prac Res Clin Endocrinol Metab. 2006 Dec;20(4):501-13. Abstract

Bastepe M. The GNAS locus and pseudohypoparathyroidism. Adv Exp Med Bio. 2008;626:27-40. Abstract

Greer FR, Krebs NF; American Academy of Pediatrics Committee on Nutrition. Optimizing bone health and calcium intakes of infants, children, and adolescents. Pediatrics. 2006 Feb;117(2):578-85.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Pseudohypoparathyroidism images
  • Differentials

    • Pseudopseudohypoparathyroidism
    • Primary hypoparathyroidism
    • Secondary hyperparathyroidism
    More Differentials
  • Guidelines

    • Recommendations for diagnosis and treatment of pseudohypoparathyroidism and related disorders: an updated practical tool for physicians and patients
    • Diagnosis and management of pseudohypoparathyroidism and related disorders: first international consensus statement
    More Guidelines
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