Endocrine Abstracts (2011) 26 P593

Hypoparathyroidism and Morbus Fahr case report

Biljana Jovanoska, Katerina Adamova, Slavica Subeska Stratrova & Iskra Bitoska

Clinic of Endocrinology, Diabetes and Metabolic Disorders, Skopje, The Former Yugoslav Republic of Macedonia.

Hypoparathyroidism is rare endocrine-metabolic disease, characterized by hypocalcemia, hyperphosphatemia and low level of the parathyroid hormone (PTH). Hypocalcemia sometimes is associated with calcifications at the basal ganglias (Morbus Fahr), leading to epileptic seizures, hypocalcemic catharacta and depression. The patient was admitted at the Clinic of endocrinology in Skopje, due to history of long term epileptic seizures, treated with antiepileptic therapy, operated from catharacta on both eyes by unknown origin and episodes of depression and complete clinical confirmation of this disease. His laboratory results showed low level of ionized Ca++ 0.47 mmol/l (1.3–1.6 mmol/l), total Ca 0.83 mmol/l (2.1–2.6 mmol/l), hyperphosphatemia P- 3.1 mmol/l (0.8–1.4 mmol/l), hypophosphaturia 10 mmol/l (20–60 mmol/l), hypocalciuria 1 mmol/l (1.3–10 mmol/l), low level of PTH 1.76 pg/ml (15–65 pg/ml), high level of LDH 1332 U/l (213–423 U/L) and CPK 1204 U/l (24–173 U/l), creatinine level 79 mmol/l (45–109 mmol/l), total proteins 76 g/l (63–83 g/l). Chvostek and Trousseau were negative. Calcifications at the basal ganglia were proven by computed tomography and nuclear magnetic resonance. Dual-energy X-ray absorptiometry (DXA) showed osteosclerosis. During the hospitalization, he was substituted with calcium gluconate parenterally, later orally with calcium carbonate a 1.5 g, Tabl.Rocaltrol a 0.5 μg and Sol.Vigantol 1200 IU. As a result of this treatment, the seizures disappeared and the antiepileptic therapy was discontinued.

Conclusion: Patients with epileptic seizures and catharacta should always be clinically and laboratory evaluated for calcium, phosphates and PTH, in order to diagnose properly and to avoid inadequate treatment.

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