Endocrine Abstracts

A 52 year old Syrian gentleman with a background history of hyperlipidaemia and psoriasis presented to the emergency department following a referral from his GP who identified severe hypocalcaemia on bloods in the community. The gentleman had been complaining of symptoms of weakness and lethargy, alongside tingling in his hands and feet for the preceding 4 years. He spoke very limited English, which may have been one of the reasons behind his non engagement with healthcare services. On presentation to the emergency department, he appeared to be comfortable and well. He was haemodynamically stable, with normal cardiorespiratory and neurological examinations. He was noted to have some muscular fasciculations in his extremities, however with no prolonged tetany. His ECG showed a borderline prolonged QTc. Bloods on admission revealed a normal FBC and renal profile, however his serum adjusted calcium was 1.35 mmol/l (2.15 – 2.5). Further biochemical evaluation revealed a corresponding parathyroid hormone level of 0.55 pmol/l (1.6 – 6.9) and a 25-OH Vitamin D level of 37 nmol/l (50 – 125). He had normal magnesium and phosphate levels. He was treated initially with repeated doses of 10% calcium gluconate, followed by a maintenance infusion. Following treatment, his serum adjusted calcium level had improved to 2.3 mmol/l and the patient symptomatically felt much better. Prior to his discharge, a genetic panel had been sent in order to look for an underlying cause of his hypoparathyroidism. He was subsequently discharged on Adcal D3, and carcitriol 1microgram/day. On his follow up in clinic, he was seen with an Arabic interpreter, and reported that his medication had run out 10 days prior, and for that matter had started experiencing symptoms of numbness and weakness once again. Repeat bloods prior to his clinic attendance revealed a serum adjusted Ca of 1.63, PTH of 0.63, and 25-OH vitamin D of 62. His genetic panel had returned negative for a genetic/familial cause of hypoparathyroidism, raising the suspicion that the hypoparathyroidism is autoimmune in nature. The patient did not display any features of other autoimmune conditions. He was issued a repeat script of medication and lifelong compliance was re-iterated. On further follow up, the patient demonstrated excellent compliance with his medication, with significant improvements both clinically and biochemically.