Hypoparathyroidism differential diagnosis: Difference between revisions

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__NOTOC__
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{{Hypoparathyroidism}}
{{Hypoparathyroidism}}
{{CMG}}; {{AE}} {{DAMI}}
{{CMG}}; {{AE}} {{Anmol}}


==Overview==
==Overview==
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
Hypoparathyroidism should be differentiated from other causes of hypocalcemia. Causes of hypocalcemia other than hypoparathyroidism include pseudohypoparathyroidism, hypomagnesemia, hypovitaminosis
chronic kidney disease, and relative hypocalcemia due to hypoalbuminemia.


OR
==Differentiating Hypoparathyroidism from other Diseases==
Hypoparathyroidism should be differentiated from other causes of hypocalcemia. Causes of hypocalcemia other than hypoparathyroidism include:
*Pseudohypoparathyroidism
**Pseudohypoparathyroidism type 1
***Pseudohypoparathyroidism type 1a
***Pseudohypoparathyroidism type 1b
***Pseudohypoparathyroidism type 1c
***Pseudopseudohypoparathyroidism
**Pseudohypoparathyroidism type 2
*Hypomagnesemia
*Hypovitaminosis
*Chronic kidney disease
*Hypoalbuminemia (relative hypocalcemia).


[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
==Differentiating X from other Diseases==
*[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
*[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
*As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].
==Differential Diagnosis==
Hypoparathyroidism should be differentiated from other causes of hypocalcemia. Causes of hypocalcemia other than hypoparathyroidism include pseudohypoparathyroidism, hypomagnesemia, hypovitaminosis, chronic kidney disease, and relative hypocalcemia due to hypoalbuminemia.
===Preferred Table===
{|
{|
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
! colspan="8" style="background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Differential diagnosis of hyperparathyroidism on the basis of hypocalcemia}}
! rowspan="2" |Diseases
! colspan="4" |Laboratory Findings
! colspan="4" |Physical Examination
! colspan="4" |History and Symptoms
! rowspan="2" |Other Findings
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Lab Test 1
!Lab Test 2
!Lab Test 3
!Lab Test 4
!Physical Finding 1
!Physical Finding 2
!Physical Finding 3
!Physical Finding 4
!Finding 1
!Finding 2
!Finding 3
!Finding 4
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 1
| colspan="2" rowspan="2" style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|'''Disorders'''}}
|style="background: #F5F5F5; padding: 5px;" |
| rowspan="2" style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|'''Mechanism of hypocalcemia'''}}
|style="background: #F5F5F5; padding: 5px;" |
! colspan="4" style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Laboratory findings}}
|style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 2
|style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Serum PTH}}
|style="background: #F5F5F5; padding: 5px;" |'''↑'''
|style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Serum Calcium}}
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Serum Phosphate}}
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Other findings}}
|style="background: #F5F5F5; padding: 5px;" |-
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 3
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''Hypoparathyroidism'''
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
|style="background: #F5F5F5; padding: 5px;" |↓
*There is deficiency of parathyroid hormone in hypoparathyroidism.
|style="background: #F5F5F5; padding: 5px;" |
*Deficiency of parathyroid hormone causes body to decrease:
|style="background: #F5F5F5; padding: 5px;" |
**Reabsorption of calcium from bone.
|style="background: #F5F5F5; padding: 5px;" |
**Excretion of phosphate.
|style="background: #F5F5F5; padding: 5px;" |
**Reabsorbtion of calcium from distal tubules.
|style="background: #F5F5F5; padding: 5px;" |
**Vitamin D mediated absorption of calcium from intestine.
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↓'''
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↓'''
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑'''
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
|style="background: #F5F5F5; padding: 5px;" |
*'''↓''' 1,25 Dihydroxy vitamin D
|style="background: #F5F5F5; padding: 5px;" |
*Normal urinary cAMP
*Normal urinary phosphate
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 4
| rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''Pseudohypoparathyroidism'''
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''Type 1a'''
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
|style="background: #F5F5F5; padding: 5px;" |
*Genetic defect causing end organ resistance to the action of parathyroid hormone (PTH)
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑'''
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↓'''
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑'''
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
|style="background: #F5F5F5; padding: 5px;" |
* '''↓''' 1,25 Dihydroxy vitamin D
|style="background: #F5F5F5; padding: 5px;" |
* '''↓''' Urinary cAMP
|style="background: #F5F5F5; padding: 5px;" |
* '''↓''' Urinary phosphate
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 5
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''Type 1b'''
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
|style="background: #F5F5F5; padding: 5px;" |
*Genetic defect causing end organ resistance to the action of parathyroid hormone (PTH)
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑'''
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↓'''
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑'''
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
|style="background: #F5F5F5; padding: 5px;" |
* '''↓''' 1,25 Dihydroxy vitamin D
|style="background: #F5F5F5; padding: 5px;" |
* '''↓''' Urinary cAMP
|style="background: #F5F5F5; padding: 5px;" |
* ↓ Urinary phosphate
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''Type 1c'''
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
|style="background: #F5F5F5; padding: 5px;" |
*Genetic defect causing end organ resistance to the action of parathyroid hormone (PTH)
|}
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑'''
 
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↓'''
===Use if the above table can not be made===
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑'''
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align=center
| style="padding: 5px 5px; background: #F5F5F5;" |
|valign=top|
* '''↓''' 1,25 Dihydroxy vitamin D
|+
* '''↓''' Urinary cAMP
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnosis}}
* '''↓''' Urinary phosphate
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Similar Features}}
|-
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Differentiating Features}}
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''Type 2'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Genetic defect causing end organ resistance to the action of parathyroid hormone (PTH)
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↓'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑'''
| style="padding: 5px 5px; background: #F5F5F5;" |
* '''↓''' 1,25 Dihydroxy vitamin D
* Normal urinary cAMP
* '''↓''' Urinary phosphate
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|Differential 1
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''Pseudopseudohypoparathyroidism'''
| style="padding: 5px 5px; background: #F5F5F5;"|
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
*Genetic defect causing end organ resistance to the action of parathyroid hormone (PTH)
| style="padding: 5px 5px; background: #F5F5F5;"|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal
| style="padding: 5px 5px; background: #F5F5F5;" | --
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|Differential 2
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''Hypomagnesemia'''<ref name="pmid26069819">{{cite journal |vauthors=Jahnen-Dechent W, Ketteler M |title=Magnesium basics |journal=Clin Kidney J |volume=5 |issue=Suppl 1 |pages=i3–i14 |year=2012 |pmid=26069819 |pmc=4455825 |doi=10.1093/ndtplus/sfr163 |url=}}</ref><ref name="pmid227929">{{cite journal |vauthors=Freitag JJ, Martin KJ, Conrades MB, Bellorin-Font E, Teitelbaum S, Klahr S, Slatopolsky E |title=Evidence for skeletal resistance to parathyroid hormone in magnesium deficiency. Studies in isolated perfused bone |journal=J. Clin. Invest. |volume=64 |issue=5 |pages=1238–44 |year=1979 |pmid=227929 |pmc=371269 |doi=10.1172/JCI109578 |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;"|
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
*Decreased parathyroid hormone (PTH) secretion
| style="padding: 5px 5px; background: #F5F5F5;"|
*Skeletal resistance to PTH
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Inappropriately '''↓'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal/'''↓'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | --
| style="padding: 5px 5px; background: #F5F5F5;" |
* '''↓''' serum magnesium
* '''↓'''/Normal serum potassium
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|Differential 3
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''Hypoalbuminemia'''
| style="padding: 5px 5px; background: #F5F5F5;"|
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
*Majority of calcium in blood is bound to albumin. So when there is a decrease in concentration of albumin due to any condition, there is a relative hypocalcemia as well.
| style="padding: 5px 5px; background: #F5F5F5;"|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | --
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↓'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | --
| style="padding: 5px 5px; background: #F5F5F5;" |
* '''↓''' serum albumin
*Normal albumin-corrected serum total calcium
*Normal ionised calcium
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|Differential 4
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''Hypovitaminosis D'''
| style="padding: 5px 5px; background: #F5F5F5;"|
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
*Decrease in vitamin D meediated calcium absorption from gut.
| style="padding: 5px 5px; background: #F5F5F5;"|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑'''
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↓'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↓'''/Low-normal
| style="padding: 5px 5px; background: #F5F5F5;" |
* '''↓''' 25 Hydroxy vitamin D
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|Differential 5
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''Chronic kidney disease'''
| style="padding: 5px 5px; background: #F5F5F5;"|
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
*[[Chronic renal failure]] leads to high serum [[inorganic phosphate]] and low serum [[calcium]] and deficiency of active form of [[vitamin D]] ([[1,25-dihydroxy vitamin D]]/[[calcitriol]])
| style="padding: 5px 5px; background: #F5F5F5;"|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑'''
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↓'''/Normal
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑'''
| style="padding: 5px 5px; background: #F5F5F5;" |
* '''↓''' Glomerular flitration rate
|}
|}


Revision as of 15:17, 3 October 2017

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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

Hypoparathyroidism should be differentiated from other causes of hypocalcemia. Causes of hypocalcemia other than hypoparathyroidism include pseudohypoparathyroidism, hypomagnesemia, hypovitaminosis chronic kidney disease, and relative hypocalcemia due to hypoalbuminemia.

Differentiating Hypoparathyroidism from other Diseases

Hypoparathyroidism should be differentiated from other causes of hypocalcemia. Causes of hypocalcemia other than hypoparathyroidism include:

  • Pseudohypoparathyroidism
    • Pseudohypoparathyroidism type 1
      • Pseudohypoparathyroidism type 1a
      • Pseudohypoparathyroidism type 1b
      • Pseudohypoparathyroidism type 1c
      • Pseudopseudohypoparathyroidism
    • Pseudohypoparathyroidism type 2
  • Hypomagnesemia
  • Hypovitaminosis
  • Chronic kidney disease
  • Hypoalbuminemia (relative hypocalcemia).
Differential diagnosis of hyperparathyroidism on the basis of hypocalcemia
Disorders Mechanism of hypocalcemia Laboratory findings
Serum PTH Serum Calcium Serum Phosphate Other findings
Hypoparathyroidism
  • There is deficiency of parathyroid hormone in hypoparathyroidism.
  • Deficiency of parathyroid hormone causes body to decrease:
    • Reabsorption of calcium from bone.
    • Excretion of phosphate.
    • Reabsorbtion of calcium from distal tubules.
    • Vitamin D mediated absorption of calcium from intestine.
 ↓ ↓ ↑
  • ↓ 1,25 Dihydroxy vitamin D
  • Normal urinary cAMP
  • Normal urinary phosphate
Pseudohypoparathyroidism Type 1a
  • Genetic defect causing end organ resistance to the action of parathyroid hormone (PTH)
 ↑ ↓ ↑
  • ↓ 1,25 Dihydroxy vitamin D
  • ↓ Urinary cAMP
  • ↓ Urinary phosphate
Type 1b
  • Genetic defect causing end organ resistance to the action of parathyroid hormone (PTH)
 ↑ ↓ ↑
  • ↓ 1,25 Dihydroxy vitamin D
  • ↓ Urinary cAMP
  • ↓ Urinary phosphate
Type 1c
  • Genetic defect causing end organ resistance to the action of parathyroid hormone (PTH)
 ↑ ↓ ↑
  • ↓ 1,25 Dihydroxy vitamin D
  • ↓ Urinary cAMP
  • ↓ Urinary phosphate
Type 2
  • Genetic defect causing end organ resistance to the action of parathyroid hormone (PTH)
 ↑ ↓ ↑
  • ↓ 1,25 Dihydroxy vitamin D
  • Normal urinary cAMP
  • ↓ Urinary phosphate
Pseudopseudohypoparathyroidism
  • Genetic defect causing end organ resistance to the action of parathyroid hormone (PTH)
 Normal Normal Normal --
Hypomagnesemia[1][2]
  • Decreased parathyroid hormone (PTH) secretion
  • Skeletal resistance to PTH
 Inappropriately ↓ Normal/↓ --
  • ↓ serum magnesium
  • ↓/Normal serum potassium
Hypoalbuminemia
  • Majority of calcium in blood is bound to albumin. So when there is a decrease in concentration of albumin due to any condition, there is a relative hypocalcemia as well.
 -- ↓ --
  • ↓ serum albumin
  • Normal albumin-corrected serum total calcium
  • Normal ionised calcium
Hypovitaminosis D
  • Decrease in vitamin D meediated calcium absorption from gut.
 ↑ ↓ ↓/Low-normal
  • ↓ 25 Hydroxy vitamin D
Chronic kidney disease ↑ ↓/Normal ↑
  • ↓ Glomerular flitration rate

References

  1. ↑ Jahnen-Dechent W, Ketteler M (2012). "Magnesium basics". Clin Kidney J. 5 (Suppl 1): i3–i14. doi:10.1093/ndtplus/sfr163. PMC 4455825. PMID 26069819.
  2. ↑ Freitag JJ, Martin KJ, Conrades MB, Bellorin-Font E, Teitelbaum S, Klahr S, Slatopolsky E (1979). "Evidence for skeletal resistance to parathyroid hormone in magnesium deficiency. Studies in isolated perfused bone". J. Clin. Invest. 64 (5): 1238–44. doi:10.1172/JCI109578. PMC 371269. PMID 227929.

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