Endocrine Abstracts

A 22 year old student sought medical attention with a month's complaint of intermittent tingling and spasms in his hands and in the last week more difficulty with phonation. He had previously been fit and active except in his neonatal period. He was a 6 weeks premature 'blue baby' and was transfused 6 times in his first week of life and received anti-D antibodies. He had mild asthma from age 2 but this no longer troubles him. He had been an otherwise fit student playing football, a non-smoker, drinking 10 pints of beer weekly and not taking recreational drugs. His GP sent off blood which showed severe hypocalcaemia.
On admission he displayed strongly positive Chvostek's and Trousseau's signs had minimal stridor but was generally comfortable. He had normal facies and hands, BP 130/80, no abnormalities in cardiac, respiratory or gastrointestinal systems. His tooth enamel was poor but dentition intact.
Initial tests revealed standard calcium 1.01 millimoles per litre (normal range 2.20 to 2.60) Magnesium 0.41 (0.7 to 1.0) Phosphate 1.89 (0.8 to 1.31), normal electrolytes, liver function and full blood count. He received magnesium, high dose Sandocal 6 grams daily and Calcitriol and his biochemistry rapidly normalised and Tetany disappeared. Other normal/negative tests included B12, folate, endomysial antibodies, 25 hydroxyvitamin D. His parathyroid hormone was elevated at 365 nanograms per litre and 409 on repeat but has normalised with continued treatment. His parents are biochemically normal. He has discontinued all treatment and his tests remain normal, probably excluding pseudohypoparathyroidism. We speculate he may have experienced temporary hypocalcaemia induced by as yet unidentified mechanisms.