Endocrine Abstracts

Case: A 30-year-old man with hypoparathyroidism has been treated with calcitriol and calcium for 2 years, admitted hospital with persisting diarrhea. An endoscopic operation is planned. But when he was waiting for this examination as outpatient condition, he had a convulsion and had been taken in hospital by parents. Initial laboratory analyses revealed that he was hypocalcemic (total calcium of 6 mg/dl) and parathormone (PTH) 8 pg/ml, phosphorus 5.7 mg/dl, and magnesium 2 mg/dl. He was treated with i.v. calcium gluconate urgently. Then treated with oral calcium gluconate and calcitriol with a stepwise increase in the dosage. An upper gastrointestinal system endoscopy has taken. Diagnosis of gluten-sensitive or celiac disease was suggested at endoscopy, due to flat mucosa and confirmed by histological findings in duodenal biopsy including absent villi, crypt hyperplasia and lymphocytic infiltration in the epithelium. Serologic examination confirmed the diagnosis. Then he was placed on gluten-free diets, which rapidly lead to the normalization of his bowel habits and improved his metabolic parameters. The needed drug dosage decreased.

Conclusion: Hypoparathyroidism is an uncommon endocrine-deficiency disease characterized by low serum calcium levels, elevated serum phosphorus levels, and absent or inappropriately low levels of PTH in the circulation. After postoperative hypoparathyroidism, autoimmune hypoparathyroidism is the next most common form of hypoparathyroidism in adults. Patients with hypoparathyroidism most often present with paresthesia, cramps, or tetany, but the disorder also may manifest acutely with seizures, bronchospasm, laryngospasm, or cardiac rhythm disturbances. Autoimmune hypoparathyroidism may be isolated or part of an autoimmune polyglandular syndrome. Celiac disease and autoimmune hypoparathyroidism togetherness is a very rare condition but the possibility of celiac disease should be considered in patients with hypoparathyroidism that seems unduly difficult to treat.