by Carlo Raj, MD

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    00:01 Our topic still continues with hypoparathyroidism.

    00:03 Botched thyroidectomy… apart from where the patient initially might have started with primary hyperparathyroidism and there might have been inadvertent, excessive parathyroidectomy resulting in hypoparathyroidism.

    00:17 If the patient is required to have a thyroidectomy because of its proximity to the parathyroids may result in excess or collateral damage to the parathyroids rendering your patient hypoparathyroid, hypocalcemic.

    00:34 Congenital deficiency... here, you should be thinking about DiGeorge syndrome.

    00:38 You have your chromosome 22, a long arm 11 deletion, therefore third and fourth pharyngeal pouches are missing, no parathyroids are present.

    00:46 In addition, the third pharyngeal pouch responsible for developing the inferior parathyroids, the patient, the child is hypocalcemic; in addition, the thymus does not form properly.

    00:57 Therefore; look for a child that is suffering from tetany, hypocalcemia; result in tetany, muscle twitching.

    01:06 In addition, there might be recurrent infection.

    01:08 Usually, it will be the viral type; malformed third and fourth pharyngeal pouches resulting in hypoparathyroidism.

    01:19 Abnormal facies, sometimes with your chromosome 22, you want to be familiar with the syndrome congenitally that the boards love asking about called velocardiofacial abnormalities.

    01:32 The velocardiofacial abnormalities may result in facies issue, congenital heart defects and cognitive behavior and psychiatric problems, autism.

    01:44 Velocardiofacial issues with chromosome 22, something that you want to know from a embryologic, pathologic point of view.

    01:54 Increased susceptibility to infection, why is that? Because the thymus may not be present, inadequate education of your T-cells, therefore rendering the patient susceptible to infection, the child.

    02:06 Other causes of hypoparathyroidism: Idiopathic, autoimmune disease resulting in parathyroid destruction. Here’s an interesting example to keep in mind: Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy syndrome, also known as polyglandular autoimmune syndrome type 1, is an inherited disorder that causes hypoparathyroidism and is associated with chronic mucocutaneous candidiasis and adrenal insufficiency.

    02:37 Lastly, infiltrative diseases are a rare cause, such as hemochromatosis, Wilson disease, granulomatous disease, or metastatic cancer.

    02:48 Clinical features include the following: whenever there is decrease in parathyroid, there will obviously be decrease in calcium and therefore, the muscle, the skeletal muscle is extremely sensitive to certain tapping.

    03:03 Tapping of the facial nerve may result in contraction of muscles of the eyes, nose and mouth and we then refer to as being Chvostek sign.

    03:13 There might be circumoral numbness or paraesthesia of distal extremity and perhaps carpopedal spasms, especially when there is a, let’s say, a brachial cuff that is placed around the arm.

    03:27 Mental status changes, QT prolongation might be seen with hypoparathyroidism and hypocalcemia; serum calcium will be low here because there’s decreased levels of PTH; decreased ability to properly evacuate the phosphate from your kidney.

    03:44 So, therefore, there will be increased phosphate levels.

    03:48 In addition, because of decreased PTH in circulation, the osteoclasts will not function as well as they should.

    03:58 And so, therefore, there will be thickening of the bone.

    04:01 The thickening of the bone, pay attention here, we’re now referring to osteoporosis, this is osteosclerosis and that to you should indicate or def-defines thickening of your bone.

    04:15 Topic… hypoparathyroidism.

    About the Lecture

    The lecture Hypoparathyroidism by Carlo Raj, MD is from the course Parathyroid Gland Disorders.

    Included Quiz Questions

    1. 22q11 deletion
    2. 11q9 deletion
    3. Trisomy 15
    4. 17q point mutation
    5. XXY karyotype
    1. 3rd and 4th branchial pouches
    2. Bilateral adrenal glands
    3. Rathke's pouch
    4. Mesodermal structures of the head and neck
    5. Structures of the lung derived from neural crest cells
    1. Tetany with neuromuscular irritability
    2. Mental status changes
    3. Circumoral numbness
    4. Osteosclerosis
    5. Carpopedal spasm

    Author of lecture Hypoparathyroidism

     Carlo Raj, MD

    Carlo Raj, MD

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