Hypoparathyroidism
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Hypoparathyroidism
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| Laboratory value | Result |
| Serum sodium | 140 mmol/L |
| Serum potassium | 4.5 mmol/L |
| Serum chloride | 97 mmol/L |
| Serum bicarbonate | 25 mmol/L |
| Serum calcium | 9.3 mmol/L |
| Serum phosphorus | 4.1 mmol/L |
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First Aid
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Chvostek sign p. 609
hypoparathyroidism p. 348
Hyperphosphatemia p. 609
hypoparathyroidism p. 348
Hypocalcemia p. 335, 609
hypoparathyroidism p. 348
pseudohypoparathyroidism p. 348
Hypoparathyroidism p. 348
Primary hypoparathyroidism p. 348
Tetany
hypoparathyroidism p. 348
Thymic aplasia p. 114, 638
hypoparathyroidism p. 348
Transcript
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With hypoparathyroidism, “hypo” refers to under, and “parathyroid” refers to the parathyroid glands, so hypoparathyroidism refers to a condition where there is an underproduction of parathyroid hormone.
Parathyroid hormone comes from the parathyroid glands which are buried within the thyroid gland, and their main job is to keep blood calcium levels stable.
Now, the majority of the extracellular calcium, the calcium in the blood and interstitium, is split almost equally between two groups - calcium that is diffusible and calcium that is not diffusible.
Diffusible calcium is small enough to diffuse across cell membranes and is separated into two subcategories.
The first is free-ionized calcium, which is involved in all sorts of cellular processes like neuronal action potentials, contraction of skeletal, smooth, and cardiac muscle, hormone secretion, and blood coagulation, all of which are tightly regulated by enzymes and hormones.
The second category is complexed calcium, which is where the positively charged calcium is ionically linked to tiny negatively charged molecules like oxalate, which is a small anion that are normally found in our blood in small amounts.
The complexed calcium forms a molecule that’s electrically neutral but unlike free-ionized calcium it’s not useful for cellular processes.
Both of these are called diffusible because they’re small enough to diffuse across cell membranes.
Finally there’s the non-diffusible calcium which is bound to negatively charged proteins like albumin.
The resulting protein-calcium complex is too large and charged to cross membranes, leaving this calcium also uninvolved in cellular processes.
Changes in the body’s levels of extracellular calcium are detected by a surface receptor in parathyroid cells that’s called the calcium-sensing receptor.
These changes affect the amount of parathyroid hormone that’s released by the parathyroid gland.
The parathyroid hormone gets the bones to release calcium, it gets the kidneys to reabsorb more calcium so it's not lost in the urine, and it synthesizes calcitriol, which is also known as 1,25-dihydroxycholecalciferol, or active Vitamin D.
Summary
Hypoparathyroidism is a condition characterized by the underproduction of parathyroid hormone (PTH). PTH is responsible for maintaining the correct levels of calcium and phosphorus in the blood. When PTH levels are low, calcium levels in the blood can drop, which can lead to symptoms like muscle weakness, cramps, and abnormal heart rhythms. Hypoparathyroidism is often caused by the surgical removal of the parathyroid glands, autoimmune destruction, or genetic conditions like DiGeorge syndrome.
Sources
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
- "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
- "Harrison's Endocrinology, 4E" McGraw-Hill Education / Medical (2016)
- "Hypoparathyroidism in the adult: Epidemiology, diagnosis, pathophysiology, target-organ involvement, treatment, and challenges for future research" Journal of Bone and Mineral Research (2011)
- "Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association" Thyroid (2012)
- "Treatment for primary hypothyroidism: current approaches and future possibilities" Drug Design, Development and Therapy (2011)
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