Hypoparathyroidism

What is Hypoparathyroidism?

Hypoparathyroidism is dwarfism that may occur in growing children when growth hormones are deficient; sometimes there is a deficiency of several hormones.

A condition called Simmonds’ disease (or, to use its longer technical term, adult panhypopituitarism) means that there has been a partial or complete destruction of the anterior pituitary leading to the deficient secretion of the various growth hormones, with failure of gonadal, thyroidal and adrenocortical function. In short, when part of the pituitary is affected or destroyed, other important gland systems are adversely affected as well. This may occur in the 20-60-years age group, and could be a result of a blocking of the blood supply to this part of the pituitary, possibly following obstetrical hemorrhage. However, as this symptom is now relatively rare (or is being treated earlier and more vigorously), the resulting condition is becoming rarer. Also, various tumors and cysts in surrounding structures may arise and cause similar symptoms.

Hypoparathyroidism Symptoms

The endocrine glands that usually receive stimulation from the pituitary reveal the deficiency in a definite sequence. Growth hormone deficiency occurs first, often without obvious symptoms. Gonadal (sex gland) failure follows ( with cessation of normal periods often being the first symptom), to be followed by reduced thyroid gland activity and finally insufficiency of the adrenal cortex – the gland situated on top of the kidneys, which produces cortisone-type hormone.

Onset is gradual, with weakness and apathy occurring, often leaving the patient too uninterested to bother to seek medical assistance. Other symptoms may be lack of menstruation, reduced sexual drive, becoming impotent (in males), sparseness of pubic, underarm and body hair, reduction in size of the genitals and breasts, facial skin becoming soft, wrinkled, pale and yellowish, and loss of coloration of the areolar tissue (surrounding the female nipple).

Thyroid failure is characterized by puffiness of the face and eyelids, dryness of the skin, constipation, slurred speech and a croaky voice, and a mental slowing down. The patient tends to become apathetic and complains of the cold.

Neurological symptoms may appear if a pituitary tumor has been responsible for the deficiency. Headaches and visual disturbances may occur.

In Hypoparathyroidism, changes occur due to insufficient amounts of parathormone being secreted into the system by the parathyroid glands.

The most common cause is when the glands have been removed either partially or completely during thyroid surgery. It can also follow when some of the parathyroid glands are surgically removed, but then it is usually a temporary deficiency, due to trauma to the remaining glands, and local swelling.

Occasionally the effect may be permanent. Occasionally unknown diseases may affect the glands, and this may be a sex-linked inherited defect.

The basic chemical change that occurs is that the blood-serum levels of calcium fall and those of phosphorus rise. As the level of calcium falls, the nervous system may become secondarily hyper excited, and if untreated, a state of tetany may occur.

Signs of a deficiency in parathormone may develop very rapidly often within 48 hours of surgery to the thyroid or parathyroid glands.

The patient may give indications of increased nervousness; seem irritable, anxious and tense. Sometimes definite mental symptoms may be in evidence, such as hallucinations, delusions or absolute dementia. Frequently the patient may complain of tingling sensations or a numb feeling about the lips, fingers and toes.

As serum-calcium levels fall further, symptoms of tetanic spasm may become more apparent. Painful cramps may take place in the lower limbs, and there may be spasms of muscle groups. The elbows and wrists may flex painfully. The hands may cup, but the lingers may tend to extend outwards. Facial muscles go into a typical spasm. If the muscles of the throat and voice box arc implicated, hoarseness may ensue, and normal talking become difficult.

In long-standing cases with no apparent cause, cataracts may develop in the lenses of the eyes (they become cloudy, impeding normal vision). The skin tends to become coarse and dry, the hair tends to fall out and monilial fungal infections are common. The pressure inside the skull rises, causing papilledema that in turn further interferes with normal vision. The teeth are adversely affected if it occurs in a young person and they become ridged and malformed.

Diagnosis of this condition is usually straightforward but may be confirmed by tests showing the typical changes in the serum levels of calcium and phosphorus.

Hypoparathyroidism Treatment

The low serum-calcium levels are raised by intravenous fluids that contain calcium gluconate and vitamin D (calciferol). As the levels start to rise and return to normal, medication may be given orally. However, it is essential that great care be taken, for symptoms may recur.

All patients must be aware of the telltale set of symptoms that could indicate a return of trouble. These include thirst, excessive urination, headaches, vomiting, diarrhea and lethargy.

Often oral calcium may be taken indefinitely, either in the form of calcium lactate of gluconate or in the more palatable effervescent forms.

Many patients tend to do well and adjust to a low calcium level, although regular blood tests for calcium levels are wise precautions.

If a tumor is present, treatment is surgical, aimed at its removal. Otherwise, “substitution therapy” is used for the various hormonal deficiencies. Cortisone medications, thyroxin or sex hormones are used, depending on the nature of the symptoms.

The outlook is usually good, provided the original cause can be diagnosed and brought under control.

These conditions are quite rare. It is likely that they will be diagnosed and best treated in the large endocrine clinics of major hospitals that have full facilities both for diagnosis and treatment.