Endocrine Abstracts

Introduction: Basal ganglia calcification or Fahr’s Syndrome is a rare form of neurological disorder. Its prevalence goes from 2 to 12.5 %. It can be primary (idiopathic) or secondary (from metabolic disorders especially from hypoparathyroidism).We present the case of a female patient with hypoparathyroidism and secondary Fahr’s Disease.

Case description: The patient L.J. 61 years old, from Pogradec, Albania, who came to the emergency room with complaints of body weakness, severe fatigue, left side numbness and headache. The patient mentioned several similar episodes during the years. A month ago, she got a head injury, with an open bleeding wound because of disorientation and extreme fatigue. The patient was being treated only for Arterial Hypertension withIrbesartan/ Amlodipin (150/5), one tablet a day.

At the emergency room, a CT of the head was performed in order to exclude acute cerebral damages. During the examination, diffuse cerebral and cerebellar calcifications were seen, identified as FAHR Disease. The patient was first hospitalised in the Neurology Department where she was treated for her immediate symptoms. During her hospital stay her blood test came as shown below: Biochemical parameters within normal range. Thyroid stimulating hormone (TSH) 3.241 U/ml (0.4–4). Total calcium 3.3 mg / dl (8.6–10.2 mg/dl). Phosphatemia 7.6 mg / dl (2.5–4.5 mg/dl). Blood Magnesium level 1.7. mg / dl (1.8–2.2 mg/dl). Calcium in 24-hour Urine 8.7 mg / day (100–300 mg/day). Phosphorous in 24-hour urine 14.2 mg/dl (400–1300). Parathyroid hormone (PTH) 1.2 ng / L (15–65 ng/ L). 25–OH–Vitamin D 15.24 ng/ml (> 30 ng/ml).

During the thyroid ultrasound, it was evident a heterogeneous bilateral structure favouring Hashimoto’s thyroiditis.

Normal electroencephalogram was obtained. The patient was later transferred in our Department because of the new found diagnosis: Primary Hypoparathyroidism, FAHR Disease and Hypovitaminosis D.

Patient began treatment with intravenous Calcium and in just a few days her symptoms became less evident. She was discharged from hospital with oral Calcium (2000 mg/day) and Vitamin D3 (2000 UI/day) and was advised to check in with her endocrinologist for future follow up.

Conclusions: Fahr’s Disease is a well-known but rare complication of hypoparathyroidism. In order to early diagnose,a thorough clinical-radiological and biochemical evaluation should be made.