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What is this condition?

Hypoparathyroidism is a deficiency of parathyroid hormone caused by disease, injury, or congenital malfunction of the parathyroid glands (pea-sized organs located behind the thyroid). Since these glands primarily regulate calcium balance, hypoparathyroidism causes calcium depletion, producing neuromuscular symptoms ranging from numbness and tingling in the arms and legs to tetany. The side effects are usually correctable with replacement therapy. However, some complications of long-term calcium deficiency, such as cataracts and calcifications within brain tissue, are irreversible.

What causes it?

Hypoparathyroidism may occur suddenly or exist as a chronic condition. There are three classifications of hypoparathyroidism:

. Idiopathic hypoparathyroidism may result from a genetic disorder or being born without any parathyroid glands.

. Acquired hypoparathyroidism often results from accidental removal of or injury to one or more parathyroid glands during surgery or, rarely, from massive thyroid radiation. Other possible causes include poor iron metabolism, lesions in various body systems, tuberculosis, cancer, or trauma.

. Reversible hypoparathyroidism may result from impaired hormone synthesis due to insufficient magnesium, from suppression of normal gland function due to excessive calcium, or from subnormal parathyroid function.

What are its symptoms?

Although mild hypoparathyroidism may cause no symptoms, it usually produces a calcium deficiency and high levels of phosphate in the blood, which affect the central nervous system as well as other body systems. Chronic hypoparathyroidism typically causes neuromuscular irritability, increased deep tendon reflexes, Chvostek's sign (hyper­irritability of the facial nerve that causes severe pain when it's tapped), difficulty swallowing, organic brain syndrome, psychosis, mental deficiency in children, and tetany (tingling, muscle tension, and spasms) that may be severe.

Other symptoms include abdominal pain; dry, lusterless hair; spontaneous hair loss; brittle fingernails that develop ridges or fall out; dry, scaly skin; cataracts; and weakened tooth enamel, which causes teeth to stain, crack, and decay easily. Depletion of blood calcium may result in irregular heartbeats and, eventually, congestive heart failure.

How is it diagnosed?

A diagnosis of hypoparathyroidism is confirmed when lab test results show reduced levels of parathyroid hormone, calcium, and phosphorus in the blood and electrocardiograph results show changes consistent with calcium depletion.

The doctor may also perform a test using a blood pressure cuff on the upper arm to help elicit possible signs of hypoparathyroidism.

How is it treated?

Treatment includes vitamin D (necessary for calcium absorption) and calcium supplements. Such therapy is usually lifelong, except for the reversible form of the disease. If the person cant tolerate the pure form of vitamin D, alternatives include Hytakerol or Rocaltrol.

Acute, life-threatening tetany requires immediate intravenous administration of 10% calcium gluconate to raise serum calcium levels. The person who's awake and able to cooperate can help raise serum calcium levels by breathing into a paper bag and then inhaling his or her own carbon dioxide; this produces hypoventilation and mild respiratory acidosis. Sedatives and antiseizure drugs may control spasms until calcium levels rise. Chronic tetany requires maintenance therapy with oral calcium and vitamin D supplements.

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