Adult primary hypoparathyroidism: A rare presentation
A 77-year-old female hypertensive and diabetic patient came with complaints of cough with purulent expectoration, shortness of breath (MMRC Grade II), and difficulty in swallowing since 2 days. She had long standing generalized weakness. She was, otherwise, in good general condition and vital signs were Pulse-80 beats/min, regular, BP-130/70 mmHg, RR-30/min, SpO2-96% on room air and Temperature 98.4 degree F. She had mild pallor, and an audible inspiratory and expiratory stridor. All other systems were normal on examination.\nBlood investigation showed low Hb counts (9.8 gms%), raised ESR (102 mm/hr), raised serum creatinine (2.01 mg/dl). Chest radiograph showed mild cardiomegaly with normal lung fields. Bronchoscopy and CT scan showed no intrabronchial obstruction, extraluminal compression of airway or other abnormalities.\nWe evaluated Serum Calcium, Phosphorus, PTH levels in view of age and long standing generalized weakness with non-specific complaints. Investigations revealed parathyroid hormone PTH-3.83 pg/ml(↓) [15-65 pg/ml], Serum Calcium-3.2 mg/dl (↓) [8.4-10.2 mg/dl], Sr. Phosphorus-11.8 mg/dl (↑) [2.4-4.5 mg/dl], S.Mg-1.6 mg/dl [1.5-2.5 mg/dl]. Serum Albumin and Vitamin D levels were normal. No nutritional, familial, congenital, infiltrative or autoimmune cause of hypoparathyroidism was obvious. Patient never had surgery or irradiation of neck.\nIn view of laboratory values showing severe hypocalcemia, hypoparathyroidism, and hyperphosphatemia, we considered the possibility of hypocalcemia induced stridor secondary to idiopathic hypoparathyroidism. Patient was treated with high dose intravenous calcium (Calcium Gluconate) and Vitamin D (Calcitriol) in addition to receiving all supportive treatments. Intake of milk and milk products was restricted in view of hyperphosphatemia. She showed immediate response to above treatment with stridor and dysphagia abating on second day of IV calcium therapy. She was discharged in a stable haemodynamic condition. On discharge, Serum calcium was 8.3 mg/dl, Serum phosphorus was 6.5 mg/dl.