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Arrab R, Benchehab Y, Guessous F, Dini N. Hypoparathyroidism Revealed by Unsuccessful Anti-epileptic Therapy. Cureus 2024; 16:e54200. [PMID: 38496170 PMCID: PMC10942805 DOI: 10.7759/cureus.54200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 03/19/2024] Open
Abstract
Pediatric hypoparathyroidism is an uncommon endocrine disease that can be either isolated or syndromic. It occurs when the secretion of parathormone is insufficient to maintain normal levels of ionized calcium. Patients with hypoparathyroidism can exhibit cerebral calcifications and metabolic disorders, and the severity of such features is inversely correlated with hypocalcemia. We report a case of a 13-year-old patient who was initially diagnosed with epilepsy by another medical team two years before her admission to our hospital and who was subjected to oral valproate therapy. The anti-epileptic therapy proved to be unsuccessful even with increasing doses. The diagnosis was corrected when we performed adequate biological investigations. This case is underlying the importance of the electrolytes profile, especially the serum phosphocalcic test, in the management of patients with new onset or recurrent epileptic seizures.
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Affiliation(s)
- Raja Arrab
- Department of Pediatrics, Mohammed VI International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
| | - Youssef Benchehab
- Department of Pediatrics, Mohammed VI International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
| | - Fadila Guessous
- Department of Biological Sciences, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
| | - Nezha Dini
- Department of Pediatrics, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
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2
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Khor ZX, Pua QY, Tai YT. Primary hypoparathyroidism: hypocalcaemia misdiagnosed as epilepsy. BMJ Case Rep 2023; 16:e257005. [PMID: 37793845 PMCID: PMC10551875 DOI: 10.1136/bcr-2023-257005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Affiliation(s)
- Zhong Xhen Khor
- Internal Medicine, Hospital Segamat, Segamat, Johor, Malaysia
| | - Qiao Ying Pua
- Medicine, Newcastle University Medicine Malaysia, Nusajaya, Johor, Malaysia
| | - Yong Ting Tai
- Medicine, Hospital Melaka, BANDAR MELAKA, Melaka, Malaysia
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Gomathy SB, Radhakrishnan DM, Das A, Srivastava AK. Idiopathic Hypoparathyroidism Presenting As New Onset Refractory Status Epilepticus. J Neurosci Rural Pract 2021; 12:796-797. [PMID: 34737518 PMCID: PMC8559069 DOI: 10.1055/s-0041-1735247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Saranya B Gomathy
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Animesh Das
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Achal K Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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4
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Mohammedin AS, Alkharashi AF, Alabdulqader AA, Abualola HA, Serih MA. Fahr's Syndrome Presenting With Hypocalcemia and Psychotic Features. Cureus 2021; 13:e18091. [PMID: 34557375 PMCID: PMC8449926 DOI: 10.7759/cureus.18091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2021] [Indexed: 11/05/2022] Open
Abstract
Fahr's disease is a rare genetic neurodegenerative disorder described as “bilateral striopallidodentate calcinosis” (BSPDC). It is characterized by calcium deposition crossing the blood-brain barrier and calcifying different brain areas. Here, we report a case of a 26-year-old Saudi young lady, known as a case of epilepsy since childhood, a major depressive disorder with psychotic features, and hypocalcemia related to hypoparathyroidism. CT brain showed extensive coarse calcifications involving the infra and supratentorial white matter, predominantly within the basal ganglia, thalami, and dentate nuclei of cerebellar hemispheres. This report will discuss the challenging presentation, clinical symptoms, and the multidisciplinary approach to manage Fahr's syndrome symptoms. In conclusion, this case emphasizes the importance of neuroimaging and metabolic workup when investigating the seizure's etiology. The goal of treatment in Fahr's syndrome is to manage the underlying conditions.
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Affiliation(s)
- Ahmed S Mohammedin
- Geriatric Medicine, Ain Shams University, Cairo, EGY.,Internal Medicine - Geriatrics, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, SAU
| | - Abdullah F Alkharashi
- Internal Medicine - Geriatrics, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, SAU
| | - Azzam A Alabdulqader
- Internal Medicine - Geriatrics, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, SAU
| | - Hossain A Abualola
- Radiology, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, SAU
| | - Mohammed A Serih
- Geriatric Medicine, Ain Shams University, Cairo, EGY.,Internal Medicine - Geriatrics, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, SAU
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5
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Borysewicz-Sańczyk H, Sawicka B, Michalak J, Wójtowicz J, Dobreńko E, Konstantynowicz J, Kemp EH, Thakker RV, Allgrove J, Hannan FM, Bossowski A. Case report: a 10-year-old girl with primary hypoparathyroidism and systemic lupus erythematosus. J Pediatr Endocrinol Metab 2020; 33:1231-1235. [PMID: 32866121 DOI: 10.1515/jpem-2020-0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 05/13/2020] [Indexed: 11/15/2022]
Abstract
Objectives Hypoparathyroidism is a rare disease in children that occurs as a result of autoimmune destruction of the parathyroid glands, a defect in parathyroid gland development or secondary to physical parathyroid gland disturbance. Typical symptoms of hypoparathyroidism present as hypocalcaemia and hyperphosphatemia due to decreased parathyroid hormone secretion and may lead to nerve and muscles disturbances resulting in clinical manifestation of tetany, arrhythmias and epilepsy. Currently, there is no conventional hormone replacement treatment for hypoparathyroidism and therapeutic approaches include normalising mineral levels using an oral calcium supplement and active forms of vitamin D. Case presentation We present the case of a 10-year-old girl with primary hypoparathyroidism who had no prior history of autoimmune disorders, but who subsequently developed systemic lupus erythematosus.
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Affiliation(s)
- Hanna Borysewicz-Sańczyk
- Department of Pediatrics, Endocrinology, Diabetology with a Cardiology Division, Medical University of Bialystok, Białystok, Poland
| | - Beata Sawicka
- Department of Pediatrics, Endocrinology, Diabetology with a Cardiology Division, Medical University of Bialystok, Białystok, Poland
| | - Justyna Michalak
- Department of Pediatrics, Endocrinology, Diabetology with a Cardiology Division, Medical University of Bialystok, Białystok, Poland
| | - Jerzy Wójtowicz
- Department of Pediatrics, Endocrinology, Diabetology with a Cardiology Division, Medical University of Bialystok, Białystok, Poland
| | - Elżbieta Dobreńko
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, Białystok, Poland
| | - Jerzy Konstantynowicz
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, Białystok, Poland
| | - E Helen Kemp
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Rajesh V Thakker
- Academic Endocrine Unit, Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Jeremy Allgrove
- Department of Pediatric Endocrinology, Great Ormond Street Hospital for Children, London, UK
| | - Fadil M Hannan
- Academic Endocrine Unit, Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK.,Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Artur Bossowski
- Department of Pediatrics, Endocrinology, Diabetology with a Cardiology Division, Medical University of Bialystok, Białystok, Poland
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Manea MM, Sirbu A, Dragos D, Dobri AM, Sirbu AG, Tuta S. EPILEPTIC SEIZURES AS THE FIRST MANIFESTATION OF FAHR'S SYNDROME. ACTA ENDOCRINOLOGICA-BUCHAREST 2020; 16:370-374. [PMID: 33363663 DOI: 10.4183/aeb.2020.370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction Hypoparathyroidism is a rare endocrine disorder, leading to complications affecting the kidneys, the eyes, the cerebrum (Fahr's syndrome, epilepsy, parkinsonism, cognitive impairment), and the heart. Case report We present the case of a 24-year old male that presented to our clinic for generalized tonic-clonic seizures increasing in frequency for the last year or so. Furthermore, he was diagnosed with subcapsular cataract of both eyes and had intraocular lens implant surgery 12 years ago. CT scan performed at admission showed calcium deposits on the dentate nuclei, basal ganglia, thalamus, cerebellum and bilateral subcortical fronto-parietal white matter compatible with Fahr's disease. The results of the laboratory tests were normal except for hypocalcemia, hyperphosphoremia and low intact parathormone (iPTH). The patient was diagnosed with primary hypoparathyroidism which led to Fahr's syndrome. The patient was prescribed oral medication including calcium carbonate, calcidiol, magnesium orotate and levetiracetam. The follow-up after three months revealed a seizure free status and normalization of magnesium, calcium, and phosphorus levels. Conclusion Fahr's syndrome can be a cause of epileptic seizures and should be considered in the clinical approach to an epileptic patient, especially in children, teenagers, and young adults.
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Affiliation(s)
- M M Manea
- "Carol Davila" University of Medicine and Pharmacy - Neurology, Bucharest, Romania.,National Institute of Neurology and Neurovascular Diseases - Neurology, Bucharest, Romania
| | - A Sirbu
- "Carol Davila" University of Medicine and Pharmacy - Endocrinology, Bucharest, Romania.,University Emergency Hospital Elias - Endocrinology, Bucharest, Romania
| | - D Dragos
- "Carol Davila" University of Medicine and Pharmacy - Medical Semiology, Bucharest, Romania.,University Emergency Hospital Bucharest - Nephrology, Bucharest, Romania
| | - A M Dobri
- National Institute of Neurology and Neurovascular Diseases - Neurology, Bucharest, Romania
| | - A G Sirbu
- National Institute of Neurology and Neurovascular Diseases - MEDINST Imagistic Center, Bucharest, Romania
| | - S Tuta
- "Carol Davila" University of Medicine and Pharmacy - Neurology, Bucharest, Romania.,National Institute of Neurology and Neurovascular Diseases - Neurology, Bucharest, Romania
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Abstract
Hypoparathyroidism is associated with a spectrum of clinical manifestations in the acute and chronic settings, from mild to debilitating. Although the acute symptoms of hypocalcemia are primarily due to neuromuscular irritability, the chronic manifestations of hypoparathyroidism may be due to the disease itself or to complications of therapy or to both. The chronic complications of hypoparathyroidism can affect multiple organ systems, including the renal, neurologic, neuropsychiatric, skeletal, and immune systems. Further research is needed to determine the pathophysiology of complications in hypoparathyroidism and whether interventions can decrease the risk of these complications.
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Affiliation(s)
- Natalie E Cusano
- Department of Medicine, Bone Metabolism Program, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, 110 East 59th Street, 8th Floor, Suite 8B, New York, NY 10022, USA.
| | - John P Bilezikian
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, 630 West 168th Street, PH 8W-864, New York, NY 10032, USA
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Patel BA, Chakor RT, Kothari KV, Nadaf S. Reversible central neural hyperexcitability: an electroencephalographic clue to hypocalcaemia. BMJ Case Rep 2017; 2017:bcr-2017-220994. [PMID: 28765190 DOI: 10.1136/bcr-2017-220994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 23-year-old male patient presented with cognitive decline and seizures. Examination revealed Chvostek's and Trousseau's signs. Investigations revealed hypocalcaemia, hyperphosphatemia and normal intact parathyroid hormone levels. Imaging showed calcifications in bilateral basal ganglia, thalamus and dentate nuclei. Interictal electroencephalogram showed theta range slowing of background activity and bilateral temporo-occipital, irregular, sharp and slow wave discharges, which accentuated during hyperventilation, photic stimulation and eye closure. Appearance of epileptiform discharges after eye closure, hyperventilation and photic stimulation may suggest presence of central neural hyperexcitability due to hypocalcaemia. These features may be an equivalent of peripheral neuromuscular hyperexcitability (Chvostek's and Trousseau's signs) that occurs in hypocalcaemia. The clinical and electroencephalographic features completely reversed with correction of serum calcium without antiepileptic medications. It is important for clinicians to recognise these reversible changes, as it can help to avoid misdiagnosis and long-term administration of antiepileptic becomes unnecessary.
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Affiliation(s)
- Bhagyadhan A Patel
- Department of Neurology, T.N.M.C and B.Y.L Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Rahul T Chakor
- Neurology, T.N.M.C and B.Y.L Nair Ch. Hospital, Mumbai, Maharasthra, India
| | - Kaumil V Kothari
- Neurology, T.N.M.C and B.Y.L Nair Ch. Hospital, Mumbai, Maharasthrs, India
| | - Swaleha Nadaf
- Neurology, T.N.M.C and B.Y.L Nair Ch. Hospital, Mumbai, maharasthra, India
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