Endocrine Abstracts

Introduction: Idiopathic hypoparathyroidism is a rare endocrine disorder with varying clinical manifestations ranging from acute hypocalcemic symptoms to asymptomatic soft and skeletal tissue calcifications/ossifications. Patients may present with wide spectrum of rheumatological manifestations, which are under-recognized, thus delaying timely treatment. This results in chronic disability.

Case presentation: A 47-year-old male with past history of convulsions and non-specific musculoskeletal symptoms presented with chronic backache for 10-years duration, with clinical findings of spinal stiffness and kyphosis suggestive of ankylosing spondylitis. He was initially managed with non-steroidal anti-inflammatory drugs and disease modifying anti-rheumatoid drugs with poor response. He was also treated with sodium valproate for adult onset seizure disorder. Further, he had intermittent numbness of hands and positive Trousseau’s and Chvostek’s signs. Radiological evaluation revealed multiple anterior osteophytes in the spine, mainly in the lumbar region and prominent end plates with shiny corners. Left iliolumbar ligament was calcified with sclerotic changes in the left sacro-iliac joint and joint space reduction mimicking spondyloarthropathy. However, HLA B27 was negative. He also had bilateral cerebral, cerebellar and basal ganglia calcification on non-contrast computed tomography of head. Biochemical evaluation confirmed hypocalcemia secondary to hypoparathyroidism. Following treatment with calcium and vitamin D, patients’ symptoms improved but skeletal changes mimiking spondyloarthropathy remained unchanged.

Conclusion: Long standing untreated hypoparathyroidism may lead to ligamental/joint ossification and calcifications resulting in spinal stiffness mimicking ankylosing spondylosis-like clinical picture. It is important to consider hypoparathyroidism as a differential diagnosis in the background of atypical spondyloarthropathies to avoid delay in diagnosis and to prevent chronic disability.