Parkinson-like syndrom as a unusual manifestation of primary hypoparathyroidism: case report
We describe case of 50-year patient with poliomyelitis in childhood, no other concomitant ilnesses, admitted in 2010 to neurologic departement of our hospital for grave parkinson-like syndrom with loss of motor function, symetric quadruparesis with spasticity, epileptic seizures and mental deterioration. These problems started about 12 months before and progressively worsened, patient was treated by levodopa and primidone. Patient was after bilateral intraocular lens implantation for cataracta of unknown origin in 40 years.
Brain CT scan reveals basal ganglia and cerebellum calcifications, blood calcium level was extremely low (1.04 mmol/l) as well as parathormone level (<5 pg/ml). Neck sonography, renal sonography, electroencephalography was without pathologic changes.
After intensive calcium i.v. supplementation (at beginning 20 mmol/day) and calcitriol supplementation patient status rapidly ameliorated. Symetric quadruparesis almost disappeared after 14-days treatment and patient was dismissed to out-patient care on peroral calcium and calcitriol medication. Next was antiparkinsonic and antiepileptic therapy diminished and 6 months after event was discontinued with no side effect.
Now, 1 year after diagnosis, patient is completely asymptomatic, with normal EEG findings, with no motor problems, fully self-sufficient, with normal ionisated and total calcium level with only substitution of calcitriol (1.5 μg daily). Screening for concomitant autoimmunities (thyroid, adrenal, pancreatic antibodies) was performed with no abnormality.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.