Short fourth and fifth metacarpals in a case of idiopathic primary hypoparathyroidism
A 22-year old woman was referred to endocrine clinic because of three episodes of generalized tonic-clonic seizure from one month ago. She was the product of consanguineous marriage. She was newly married and had no children. As far as she knew, family history was negative for similar disorder or other endocrine problems. She had normal regular menses. She was an oriented female with normal face appearance and short body stature (her height was 153 cm; her weight and BMI were 60 kg and 25.6 kg/ m2 respectively).\nShe had normal vital signs:\nBP: 100/70 mm Hg, Temperature: 37°C, Pulse rate: 80/ min and regular, Respiratory rate: 16/min.\nPhysical exam revealed shortening of fourth and fifth metacarpal in both hands with greater degree of fourth metacarpal involvement in right hand. The knuckles of her ring and little fingers looked depressed during clinching fist position [Figures and ]. Hands movements and function were normal. Radiograph study of hands showed short fourth and fifth metacarpal in both hands []. Deep tendon reflexes were normal and plantar reflexes were flexor. Chvostek's and Trousseau's signs were negative at the time of admission to endocrine ward.\nLaboratory results showing the following results: WBC: 7700/μl, hemoglobin (Hb):11.7g/dl, mean cell volume (MCV): 84 (fl), platelet (Plt):255,000/μl), blood urea: 19mg/dl, Cr: 0.8 mg/dl, blood sugar: 73 mg/dl, Potassium: 3.6 mEq/L, Sodium: 141 mEq/L, calcium:5.3-7.1 mg/ dl (8.5-10.4), Ionized calcium: 3.88 mg/dl (4.6-5.3), serum phosphorus:6.4-7.3 mg/dl (2.8-4.5), serum Mg (magnesium): 2.20 mg/dl (1.8-2.6), serum ALP (serum Alkaline phosphatase):162 IU/L (64-306), Intact PTH: 17.91pg/ml (15-65), serum Albumin: 4.2 gr/dl (3.5-5.2). Liver function, urine analysis and thyroid function tests were all normal. Erythrocyte sedimentation rate (ESR) was 17 mm/hour and RF (Rheumatoid factor) was negative.\nThere were transient sharp epileptiform discharges in both frontocentral regions predominantly in right side in Electroencephalography (EEG) study.\nCXR and ECG results were normal.\nBrain magnetic resonance imaging (MRI) revealed multiple abnormal signal foci at subcortical white matter and there was no space occupying lesion.\nThere were nonspecific nonenhancing T2 and FLAIR high signal foci at left forceps major area in brain magnetic resonance imaging (MRI) with and without contrast.\nWe made the diagnosis of IPH and she was initiated on intravenous calcium infusion along with oral calcium tablets, calcitriol and also sodium valproate and after controlling of her hypocalcemia she was discharged to home and she was advised to return to the clinic for periodic monitoring with serum calcium and phosphorous levels and 24 hours urinary calcium collection.