EXTENSIVE INTRACRANIAL CALCIFICATIONS DUE TO HYPOPARATHYROIDISM

Mellos A, Michail A, Papageorgiou K, Plakias S, Arxontis E.

2th Department of Internal Medicine, General Hospital of Karditsa

INTRODUCTION-DESCRIPTION

3

Conclusions

• Post-surgical hypoparathyroidism occurs after thyroid surgery, parathyroidectomy and laryngectomy.

• Transient hypoparathyroidism occurs in 36.4% of cases after thyroidectomy

• The incidence of permanent hypoparathyroidism is estimated between 0.9% and 12.1% after thyroidectomy.

• Total thyroidectomy due to Grave’s disease or thyroid cancer is associated with higher rates of hypocalcemia than hemi-thyroidectomy.

• Removal of all the parathyroid glands or vascular compromise- due to fibrosis in the neck after surgery - are the main causes of post-surgical hypoparathyroidism.

• Hypocalcemia due to hypoparathyroidism may be asymptomatic or may present with paresthesia, painful muscle spasm of hands and feet, facial muscle cramps, seizures, parkinsonism, cognitive impairment, psychosis or depression.

• Brain calcifications can occur in persistent hypocalcemia. A non-enhanced CT scan shows bilateral and symmetrical calcifications in basal ganglia and the cerebellum. Extensive intracranial calcification, as in our case, is less common and most often seen in idiopathic hypoparathyroidism than iatrogenic hypoparathyroidism.

• Other diagnosis that should be evoked on a CT scan include:

1. Fahr disease 2. Basal ganglia calcifications in trisomy 21, radiation

therapy or intrathecal chemotherapy 3. neurolupus

• The mechanism of brain calcinosis has not yet been understood. It seems that hyperphosphatemia and the presence of several osteogenic molecules play a critical role in this ectopic calcification.

• FOR THIS REASON the primary goals of mamanagement of permanent hypoparathyroidism with vitamin D and calcium are to achieve

A LEVEL OF CALCIUM IN THE LOW-NORMAL AND A LEVEL OF SERUM PHOSPHORUS WITHIN THE

NORMAL RANGE

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