Hypoparathyroidism physical examination: Difference between revisions

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{{Hypoparathyroidism}}
{{Hypoparathyroidism}}


{{CMG}}; {{AE}} {{DAMI}}
{{CMG}}; {{AE}} {{Anmol}}


==Overview==
==Overview==
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
Physical examination of patients with hypoparathyroidism is usually due to [[hypocalcemia]]. The presence of [[tetany]] on physical examination is diagnostic of [[hypocalcemia]] which is commonly caused by hypoparathyroidism. The presence of [[Chvostek's sign]] and [[Trousseau's sign|Trousseau's sign]] on physical examination is highly suggestive of [[hypocalcemia]] which is commonly caused by hypoparathyroidism.


OR
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
OR
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
==Physical Examination==
==Physical Examination==
 
*Physical examination of patients with hypoparathyroidism is usually due to [[hypocalcemia]].<ref name="pmid28138323">{{cite journal |vauthors=Abate EG, Clarke BL |title=Review of Hypoparathyroidism |journal=Front Endocrinol (Lausanne) |volume=7 |issue= |pages=172 |year=2016 |pmid=28138323 |pmc=5237638 |doi=10.3389/fendo.2016.00172 |url=}}</ref><ref name="pmid18535072">{{cite journal |vauthors=Cooper MS, Gittoes NJ |title=Diagnosis and management of hypocalcaemia |journal=BMJ |volume=336 |issue=7656 |pages=1298–302 |year=2008 |pmid=18535072 |pmc=2413335 |doi=10.1136/bmj.39582.589433.BE |url=}}</ref>
*Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
*The presence of [[tetany]] on physical examination is diagnostic of [[hypocalcemia]] which is commonly caused by hypoparathyroidism.<ref>{{cite book |last1=Schafer |first1=AL |last2=Shoback |first2=DM |editor-last1=De Groot |editor-first1=LJ |editor-last2=Chrousos |editor-first2=G |editor-last3=Dungan |editor-first3=K  |display-editors=etal |date= |title=Hypocalcemia: Diagnosis and Treatment. [Updated 2016 Jan 3]. |url=https://www.ncbi.nlm.nih.gov/books/NBK279022/ |location= Endotext [Internet]. |publisher=South Dartmouth (MA): MDText.com, Inc.; 2000-. |page= |isbn= |author-link= }}</ref>
*The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*The presence of [[Chvostek's sign]] and [[Trousseau's sign|Trousseau's sign]] on physical examination is highly suggestive of [[hypocalcemia]] which is commonly caused by hypoparathyroidism.<ref name="pmid18650515">{{cite journal |vauthors=Shoback D |title=Clinical practice. Hypoparathyroidism |journal=N. Engl. J. Med. |volume=359 |issue=4 |pages=391–403 |year=2008 |pmid=18650515 |doi=10.1056/NEJMcp0803050 |url=}}</ref>
*The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


===Appearance of the Patient===
===Appearance of the Patient===
*Patients with hypoparathyroidism usually have neuromuscular irritability and may appear dysphoretic.
*Patients with hypoparathyroidism usually have [[neuromuscular]] [[irritability]] and may appear [[dysphoric]].


===Vital Signs===
===Vital Signs===
Some patient may have:
*[[Bradycardia]]


*High-grade / low-grade fever
===Skin===
*[[Hypothermia]] / hyperthermia may be present
Careful examination of [[skin]] around [[neck]] should be done for [[surgical]] scar.
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]


===Skin===
Common signs present are:
Common signs are:
*[[Dry skin]]
*Dry skin
*Coarse [[hair]]
*Coarse hair
*[[Brittle nails]]
*Brittle nails
*[[Alopecia]] (patchy)
*Alopecia (patchy)
Some patient may have:
Some patient may have:
*Atopic eczema
*[[Vitiligo]]
*Exfoliative dermatitis
*Psoriasis
*Impetigo herpetiformis


===HEENT===
===HEENT===
Some patients may have:
Some patients may have:
*Subcapsular cataracts
*Subcapsular [[cataracts]]
*Papilledema
*[[Papilledema]]<ref name="pmid3690435">{{cite journal |vauthors=Sheldon RS, Becker WJ, Hanley DA, Culver RL |title=Hypoparathyroidism and pseudotumor cerebri: an infrequent clinical association |journal=Can J Neurol Sci |volume=14 |issue=4 |pages=622–5 |year=1987 |pmid=3690435 |doi= |url=}}</ref>


===Dental signs===
===Dental signs===
*Enamel hypoplasia
Some pediatric patients may have:
*Shortened premolar roots
*[[Enamel]] [[hypoplasia]]
*Shortened [[premolar]] roots
*Thickened lamina dura
*Thickened lamina dura
*Delayed tooth eruption
*Delayed tooth eruption
*Increased dental caries
*[[Dental caries]]
 
===Neck===
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]


===Lungs===
===Lungs===
Dyspnea
Some patients may have:
Wheezing
*[[Dyspnea]]
*[[Wheeze|Wheezing]]


===Heart===
===Heart===
Prolonged QT interval on EKG
Some patients may have:
Congestive heart failure
*[[Palpitation]]
Cardiomyopathy
*Signs of [[congestive heart failure]] such as [[fluid overload]] ([[S3 gallop]])<ref name="pmid4014262">{{cite journal |vauthors=Levine SN, Rheams CN |title=Hypocalcemic heart failure |journal=Am. J. Med. |volume=78 |issue=6 Pt 1 |pages=1033–5 |year=1985 |pmid=4014262 |doi= |url=}}</ref>
 
* Signs of [[cardiomyopathy]]<ref name="pmid1633370">{{cite journal |vauthors=Kudoh C, Tanaka S, Marusaki S, Takahashi N, Miyazaki Y, Yoshioka N, Hayashi M, Shimamoto K, Kikuchi K, Iimura O |title=Hypocalcemic cardiomyopathy in a patient with idiopathic hypoparathyroidism |journal=Intern. Med. |volume=31 |issue=4 |pages=561–8 |year=1992 |pmid=1633370 |doi= |url=}}</ref>


===Abdomen===
===Abdomen===
Dysphagia
Some patients may have:
 
* [[Dysphagia]]
===Back===
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump
 
===Genitourinary===
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
===Neuromuscular===
Most common presentation is due to neuromuscular irritability. It present as:
Most common presentation is due to neuromuscular irritability. It present as:
*Tetany
*[[Tetany|'''Tetany''']]
*Chvostek's sign - Facial twitching, especially around the mouth. It is elicited by gently tapping the ipsilateral facial nerve as it courses just anterior to the ear.
*'''[[Chvostek's sign]]:''' [[Facial twitching]], especially around the [[mouth]]. It is elicited by tapping the [[cheek]] (2 cm anterior to the earlobe below the [[zygomatic process]]) over the path of the [[facial nerve]]. Ipsilateral [[twitching]] of the upper [[lip]] is considered as positive sign.
*Trousseau's sign - Carpal spasm. It is elicited by inflating a blood pressure cuff around the arm to a pressure 20 mm Hg above obliteration of the radial pulse for 3-5 minutes.
*'''[[Trousseau's sign]]:''' Painful carpal spasm. It is elicited by inflating a [[blood pressure]] cuff around the arm to a pressure 20 mm Hg above obliteration of the [[radial pulse]] for 3-5 minutes.
*Tingling, burning, or numbness in the fingertips, toes and lips.
*[[Tingling]], burning, and/or [[numbness]] in the [[Fingertip|fingertips]], [[Toe|toes]] and [[lips]]
*Muscle weakness
*[[Muscle weakness]]
*Extrapyramidal signs (due to calcification of basal ganglia)
*Signs of [[increased intracranial pressure]]
*Anxiety
*[[Dystonic]] [[spasms]]
*Depression
*Irritability
*Impaired intellectual ability
*Nonspecific EEG changes
*Signs of increased intracrania pressure
Confusion
Disorientation
Psychosis
Anxiety
Poor memory
Reduced concentration
Dystonic spasms
Some patients may have:
Some patients may have:
Parkinsonism
*[[Intellectual disability]]
Choreoathetosis
*[[Confusion]]
*[[Disorientation]]
Some patients may have [[extrapyramidal]] signs (due to [[calcification]] of [[basal ganglia]]):<ref name="pmid22224190">{{cite journal |vauthors=Basak RC |title=A case report of Basal Ganglia calcification - a rare finding of hypoparathyroidism |journal=Oman Med J |volume=24 |issue=3 |pages=220–2 |year=2009 |pmid=22224190 |pmc=3251182 |doi=10.5001/omj.2009.44 |url=}}</ref>
*[[Parkinsonism]]
*[[Choreoathetosis]]
*[[Dystonia]]
*[[Oculogyric crisis]]
*[[Hemiballismus]]
 
===Psychiatric===
Some patients may have psychiatric manifestations:<ref name="pmid11834431">{{cite journal |vauthors=Arlt W, Fremerey C, Callies F, Reincke M, Schneider P, Timmermann W, Allolio B |title=Well-being, mood and calcium homeostasis in patients with hypoparathyroidism receiving standard treatment with calcium and vitamin D |journal=Eur. J. Endocrinol. |volume=146 |issue=2 |pages=215–22 |year=2002 |pmid=11834431 |doi= |url=}}</ref><ref name="pmid25772947">{{cite journal |vauthors=Lin KF, Chen KH, Huang WL |title=Organic anxiety in a woman with breast cancer receiving denosumab |journal=Gen Hosp Psychiatry |volume=37 |issue=2 |pages=192.e7–8 |year=2015 |pmid=25772947 |doi=10.1016/j.genhosppsych.2015.01.007 |url=}}</ref>
*[[Anxiety]]
*[[Depression]]
*[[Irritability]]
*[[Psychosis]]
*[[Anxiety]]
*Memory disturbances
*Reduced concentration


===Extremities===
===Extremities===
*[[Clubbing]]
Some patients may have:
*[[Cyanosis]]  
*[[Edema]] due to [[cardiac dysfunction]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==
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[[Category:Disease]]
[[Category:Medicine]]
[[Category:Endocrinology]]
[[Category:Parathyroid disorders]]
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Latest revision as of 22:18, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2]

Overview

Physical examination of patients with hypoparathyroidism is usually due to hypocalcemia. The presence of tetany on physical examination is diagnostic of hypocalcemia which is commonly caused by hypoparathyroidism. The presence of Chvostek's sign and Trousseau's sign on physical examination is highly suggestive of hypocalcemia which is commonly caused by hypoparathyroidism.

Physical Examination

Appearance of the Patient

Vital Signs

Some patient may have:

Skin

Careful examination of skin around neck should be done for surgical scar.

Common signs present are:

Some patient may have:

HEENT

Some patients may have:

Dental signs

Some pediatric patients may have:

Lungs

Some patients may have:

Heart

Some patients may have:

Abdomen

Some patients may have:

Neuromuscular

Most common presentation is due to neuromuscular irritability. It present as:

Some patients may have:

Some patients may have extrapyramidal signs (due to calcification of basal ganglia):[8]

Psychiatric

Some patients may have psychiatric manifestations:[9][10]

Extremities

Some patients may have:

References

  1. Abate EG, Clarke BL (2016). "Review of Hypoparathyroidism". Front Endocrinol (Lausanne). 7: 172. doi:10.3389/fendo.2016.00172. PMC 5237638. PMID 28138323.
  2. Cooper MS, Gittoes NJ (2008). "Diagnosis and management of hypocalcaemia". BMJ. 336 (7656): 1298–302. doi:10.1136/bmj.39582.589433.BE. PMC 2413335. PMID 18535072.
  3. Schafer, AL; Shoback, DM. De Groot, LJ; Chrousos, G; Dungan, K; et al., eds. Hypocalcemia: Diagnosis and Treatment. [Updated 2016 Jan 3]. Endotext [Internet].: South Dartmouth (MA): MDText.com, Inc.; 2000-.
  4. Shoback D (2008). "Clinical practice. Hypoparathyroidism". N. Engl. J. Med. 359 (4): 391–403. doi:10.1056/NEJMcp0803050. PMID 18650515.
  5. Sheldon RS, Becker WJ, Hanley DA, Culver RL (1987). "Hypoparathyroidism and pseudotumor cerebri: an infrequent clinical association". Can J Neurol Sci. 14 (4): 622–5. PMID 3690435.
  6. Levine SN, Rheams CN (1985). "Hypocalcemic heart failure". Am. J. Med. 78 (6 Pt 1): 1033–5. PMID 4014262.
  7. Kudoh C, Tanaka S, Marusaki S, Takahashi N, Miyazaki Y, Yoshioka N, Hayashi M, Shimamoto K, Kikuchi K, Iimura O (1992). "Hypocalcemic cardiomyopathy in a patient with idiopathic hypoparathyroidism". Intern. Med. 31 (4): 561–8. PMID 1633370.
  8. Basak RC (2009). "A case report of Basal Ganglia calcification - a rare finding of hypoparathyroidism". Oman Med J. 24 (3): 220–2. doi:10.5001/omj.2009.44. PMC 3251182. PMID 22224190.
  9. Arlt W, Fremerey C, Callies F, Reincke M, Schneider P, Timmermann W, Allolio B (2002). "Well-being, mood and calcium homeostasis in patients with hypoparathyroidism receiving standard treatment with calcium and vitamin D". Eur. J. Endocrinol. 146 (2): 215–22. PMID 11834431.
  10. Lin KF, Chen KH, Huang WL (2015). "Organic anxiety in a woman with breast cancer receiving denosumab". Gen Hosp Psychiatry. 37 (2): 192.e7–8. doi:10.1016/j.genhosppsych.2015.01.007. PMID 25772947.

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