Summary
Definition
History and exam
Key diagnostic factors
- history of thyroid, parathyroid or laryngeal surgery
- chronic alcoholism
- malnutrition, malabsorption, diarrhea
- muscle twitches, spasms, cramps
- paresthesias, numbness, tingling
- poor memory, slowed thinking
- Chvostek sign
- convulsions
- irregular heart beat, tachycardia
- Trousseau sign
Other diagnostic factors
- anxiety
- dry hair, brittle nails
- cataracts
- history of mucocutaneous candidiasis
- history of chronic transfusions in patients with thalassemia
- dyspnea
- laryngeal spasm
Risk factors
- thyroid surgery
- parathyroid surgery
- hypomagnesemia
- moderate and chronic maternal hypercalcemia (neonatal hypocalcemia)
- autosomal dominant conditions (e.g., mutations in CASR, GATA3)
- hereditary hemochromatosis
- transfusional iron overload in thalassemia
- metastatic cancer
Diagnostic investigations
1st investigations to order
- serum calcium
- serum albumin
- ECG
- plasma intact PTH
- serum magnesium
- serum 25-hydroxyvitamin D
- serum phosphorus
- serum creatinine
Investigations to consider
- 24-hour urine calcium, creatinine
- 24-hour magnesium, creatinine
- liver function tests
- arterial blood gases (ABGs)
- serum free T4, thyrotropin
- morning cortisol and adrenocorticotropin (ACTH) stimulation testing
- complete blood count
- serum iron, transferrin, ferritin
- serum copper
- ophthalmologic exam
- audiology
- renal imaging
- gene sequencing
Treatment algorithm
Contributors
Authors
Professor of Medicine
University of California San Francisco
Endocrine Research Unit
San Francisco VA Medical Center
San Francisco
CA
Disclosures
DS worked as a consultant for SHIRE Pharmaceuticals. She has received honorarium from Neopharma, and served as an expert witness for a patient-based malpractice case. For the past 5 years, DS was a speaker for the annual patients and caregivers conference on hypoparathyroidism for the US-based Hypoparathyroidism Association, and is an unpaid member of their medical advisory board. DS has given many CME lectures on hypoparathyroidism and all kinds of calcium and bone and mineral disorders.
Professor of Surgery
Section of Endocrine Surgery
University of California San Francisco
San Francisco
CA
Disclosures
QYD declares that he has no competing interests.
Professors Dolores Shoback and Quan-Yang Duh would like to gratefully acknowledge Professor Ronald Merrell, a previous contributor to this topic. RM declares that he has no competing interests.
Peer reviewers
Adjunct Clinical Professor
Department of Family Medicine
University of North Carolina
Chapel Hill
NC
Disclosures
WM declares that he has no competing interests.
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