eMedicine Specialties > Emergency Medicine > Endocrine & Metabolic

Hypoparathyroidism: Differential Diagnoses & Workup

Author: David J Wallace, MD, MPH, Critical Care Medicine Fellow, University of Pittsburgh Medical Center
Coauthor(s): Agnieszka Gliwa, MD, Assistant Professor of Medicine, State University of New York Downstate Medical Center College of Medicine, Brooklyn; Attending Physician and Endocrinologist, Staten Island University Hospital
Contributor Information and Disclosures

Updated: Apr 15, 2009

Differential Diagnoses

Candidiasis
Hypomagnesemia
Hypermagnesemia
Hypoparathyroidism
Hyperphosphatemia
Renal Failure, Acute
Hyperventilation Syndrome
Renal Failure, Chronic and Dialysis Complications
Hypocalcemia

Other Problems to Be Considered

Increased protein binding of calcium
Pseudohypoparathyroidism
Vitamin D deficiency
Rickets and osteomalacia
Addison disease
Pernicious anemia

Workup

Laboratory Studies

  • The diagnosis of hypoparathyroidism is supported by hypocalcemia, hyperphosphatemia, and low parathyroid hormone levels in the absence of renal failure or intestinal malabsorption. 
  • Both total and ionized calcium are decreased. Normal total serum calcium levels range from 9-10.5 mg/dL (2.2-2.6 mmol/L). Normal ionized calcium levels are 4.5-5.6 mg/dL (1.1-1.4 mmol/L). 
  • Serum magnesium level can be low, high, or normal.
  • Transient symptomatic hypocalcemia can occur immediately after thyroid surgery; normal PTH levels 3 hours after surgery and a normal serum calcium level on the postoperative day one rules out persistent hypoparathyroidism.34

Imaging Studies

  • Radiography: Bone density is increased35 ; tooth enamel and root abnormalities have been described.36 Ossification of the paravertebral ligaments is frequently observed.37  
  • CT scan: Calcification of subcortical nuclei, dentate nucleus,38 and basal ganglia39 can occur.

Other Tests

  • ECG may show prolonged QT interval40 , bradycardia, or rarely ST-segment elevations.14
  • For D-xylose absorption test, the results are usually normal.41

Procedures

  • Slit lamp examination for cataracts21

More on Hypoparathyroidism

Overview: Hypoparathyroidism
Differential Diagnoses & Workup: Hypoparathyroidism
Treatment & Medication: Hypoparathyroidism
Follow-up: Hypoparathyroidism
References
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References

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  45. Harzy T, Benbouazza K, Amine B, Rahmouni R, Guedira N, Hajjaj-Hassouni N. Idiopathic hypoparathyroidism and adhesive capsulitis of the shoulder in two first-degree relatives. Joint Bone Spine. May 2004;71(3):234-6. [Medline].

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Further Reading

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Keywords

hypoparathyroidism, parathyroid hormone, PTH, hypocalcemia, hypomagnesemia, pseudohypoparathyroidism, parathyroid glands, parathyroid aplasia, DiGeorge syndrome, congenital hypoparathyroidism, parathyroid adenoma, sarcoidosis, Wilson disease, hemochromatosis, metastatic carcinoma, hypermagnesemia, autoimmune polyglandular syndrome type 1, Kenny syndrome, drug-induced hypoparathyroidism, suppression of parathyroid gland, Sanjat-Sakati syndrome, HDR syndrome, Kenny-Caffey syndrome, Pearson's marrow-pancreas syndrome, Pearson marrow-pancreas syndrome

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Contributor Information and Disclosures

Author

David J Wallace, MD, MPH, Critical Care Medicine Fellow, University of Pittsburgh Medical Center
David J Wallace, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American Medical Association, Emergency Medicine Residents Association, Society for Academic Emergency Medicine, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Agnieszka Gliwa, MD, Assistant Professor of Medicine, State University of New York Downstate Medical Center College of Medicine, Brooklyn; Attending Physician and Endocrinologist, Staten Island University Hospital
Agnieszka Gliwa, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians-American Society of Internal Medicine, American Medical Association, and Endocrine Society
Disclosure: Nothing to disclose.

Medical Editor

Erik D Schraga, MD, Consulting Staff, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates; Consulting Staff, Permanente Medical Group, Kaiser Permanente, Santa Clara Medical Center
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Howard A Bessen, MD, Professor of Medicine, Department of Emergency Medicine, UCLA School of Medicine; Program Director, Harbor-UCLA Medical Center
Howard A Bessen, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD, Consulting Staff, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates; Consulting Staff, Permanente Medical Group, Kaiser Permanente, Santa Clara Medical Center
Disclosure: Nothing to disclose.

 
 
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