Hypoparathyroidism differential diagnosis: Difference between revisions

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Revision as of 15:32, 3 October 2017

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 D, 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 D
Chronic kidney disease
Hypoalbuminemia (relative hypocalcemia).

Differential diagnosis of hyperparathyroidism on the basis of hypocalcemia
Disorders		Mechanism of hypocalcemia	Laboratory findings
Disorders		Mechanism of hypocalcemia	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. Reabsorption 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 parathyroid hormone.	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 ionized calcium
Hypovitaminosis D		Decrease in vitamin D mediated calcium absorption from intestine.	↑	↓	↓/Low-normal	↓ 25 Hydroxy vitamin D
Chronic kidney disease		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)	↑	↓/Normal	↑	↓ Glomerular filtration rate

References

↑ 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.
↑ 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.

Template:WH Template:WS

[pmid26069819-1] 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.

[pmid227929-2] 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.

[1]

[2]

@@ Line 4: / Line 4: @@
 ==Overview==
-Hypoparathyroidism should be differentiated from other causes of hypocalcemia. Causes of hypocalcemia other than hypoparathyroidism include pseudohypoparathyroidism, hypomagnesemia, hypovitaminosis
+Hypoparathyroidism should be differentiated from other causes of [[hypocalcemia]]. Causes of [[hypocalcemia]] other than hypoparathyroidism include [[pseudohypoparathyroidism]], [[hypomagnesemia]], [[Vitamin D deficiency|hypovitaminosis D]], [[chronic kidney disease]], and relative [[hypocalcemia]] due to [[hypoalbuminemia]].
-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]]
 **Pseudohypoparathyroidism type 1
 ***Pseudohypoparathyroidism type 1a
@@ Line 16: / Line 15: @@
 ***Pseudopseudohypoparathyroidism
 **Pseudohypoparathyroidism type 2
-*Hypomagnesemia
+*[[Hypomagnesemia]]
-*Hypovitaminosis
+*[[Vitamin D deficiency|Hypovitaminosis D]]
-*Chronic kidney disease
+*[[Chronic kidney disease]]
-*Hypoalbuminemia (relative hypocalcemia).
+*[[Hypoalbuminemia]] (relative [[hypocalcemia]]).
 {|
-! colspan="8"  style="background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Differential diagnosis of hyperparathyroidism on the basis of hypocalcemia}}
+! colspan="8" style="background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Differential diagnosis of hyperparathyroidism on the basis of hypocalcemia}}
 |-
 | colspan="2" rowspan="2" style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|'''Disorders'''}}
@@ Line 28: / Line 27: @@
 ! colspan="4" style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Laboratory findings}}
 |-
-|style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Serum PTH}}
+| style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Serum PTH}}
-|style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Serum Calcium}}
+| style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Serum Calcium}}
-|style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Serum Phosphate}}
+| style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Serum Phosphate}}
-|style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Other findings}}
+| style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Other findings}}
 |-
 | colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''Hypoparathyroidism'''
 | style="padding: 5px 5px; background: #F5F5F5;" |
-*There is deficiency of parathyroid hormone in hypoparathyroidism.
+*There is deficiency of [[parathyroid hormone]] in hypoparathyroidism.
-*Deficiency of parathyroid hormone causes body to decrease:
+*Deficiency of [[parathyroid hormone]] causes body to decrease:
-**Reabsorption of calcium from bone.
+**[[Reabsorption]] of [[calcium]] from [[bone]].
-**Excretion of phosphate.
+**[[Excretion]] of [[phosphate]].
-**Reabsorbtion of calcium from distal tubules.
+**[[Reabsorption]] of [[calcium]] from [[distal tubules]].
-**Vitamin D mediated absorption of calcium from intestine.
+**[[Vitamin D]] mediated [[absorption]] of [[calcium]] from [[intestine]].
 | 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
+*'''↓''' [[1,25-dihydroxy vitamin D|1,25 Dihydroxy vitamin D]]
-*Normal urinary cAMP
+*Normal [[urinary]] [[cAMP]]
-*Normal urinary phosphate
+*Normal [[urinary]] [[phosphate]]
 |-
 | rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''Pseudohypoparathyroidism'''
@@ Line 57: / Line 56: @@
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑'''
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* '''↓''' 1,25 Dihydroxy vitamin D
+* '''↓''' [[1,25-dihydroxy vitamin D|1,25 Dihydroxy vitamin D]]
-* '''↓''' Urinary cAMP
+* '''↓''' [[Urinary]] [[cAMP]]
-* '''↓''' Urinary phosphate
+* '''↓''' [[Urinary System|Urinary]] [[phosphate]]
 |-
 | style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''Type 1b'''
@@ Line 68: / Line 67: @@
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑'''
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* '''↓''' 1,25 Dihydroxy vitamin D
+* '''↓''' [[1,25-dihydroxy vitamin D|1,25 Dihydroxy vitamin D]]
-* '''↓''' Urinary cAMP
+* '''↓''' [[Urinary]] [[cAMP]]
-* ↓ Urinary phosphate
+* '''↓''' [[Urinary System|Urinary]] [[phosphate]]
 |-
 | style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''Type 1c'''
@@ Line 79: / Line 78: @@
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑'''
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* '''↓''' 1,25 Dihydroxy vitamin D
+* '''↓''' [[1,25-dihydroxy vitamin D|1,25 Dihydroxy vitamin D]]
-* '''↓''' Urinary cAMP
+* '''↓''' [[Urinary]] [[cAMP]]
-* '''↓''' Urinary phosphate
+* '''↓''' [[Urinary System|Urinary]] [[phosphate]]
 |-
 | style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''Type 2'''
@@ Line 90: / Line 89: @@
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑'''
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* '''↓''' 1,25 Dihydroxy vitamin D
+* '''↓''' '''↓''' [[1,25-dihydroxy vitamin D|1,25 Dihydroxy vitamin D]]
-* Normal urinary cAMP
+* Normal [[urinary]] [[cAMP]]
-* '''↓''' Urinary phosphate
+* '''↓''' [[Urinary]] [[phosphate]]
 |-
 | style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''Pseudopseudohypoparathyroidism'''
@@ Line 104: / Line 103: @@
 | 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;" |
-*Decreased parathyroid hormone (PTH) secretion
+*Decreased [[parathyroid hormone]] (PTH) secretion.
-*Skeletal resistance to PTH
+*[[Skeleton|Skeletal]] resistance to [[parathyroid hormone]].
 | 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
+* '''↓''' [[Serum]] [[magnesium]]
-* '''↓'''/Normal serum potassium
+* '''↓'''/Normal [[serum]] [[potassium]]
 |-
 | colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''Hypoalbuminemia'''
 | style="padding: 5px 5px; background: #F5F5F5;" |
-*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.
+*Majority of [[calcium]] in [[blood]] is bound to [[albumin]]. So, when there is a [[Hypoalbuminemia|decrease in concentration of albumin]] due to any condition, there is a relative [[hypocalcemia]] as well.
 | 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;" |
-* '''↓''' serum albumin
+* '''↓''' [[Serum albumin]]
 *Normal albumin-corrected serum total calcium
-*Normal ionised calcium
+*Normal [[ionized]] [[calcium]]
 |-
 | colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''Hypovitaminosis D'''
 | style="padding: 5px 5px; background: #F5F5F5;" |
-*Decrease in vitamin D meediated calcium absorption from gut.
+*Decrease in [[vitamin D]] mediated [[calcium]] [[absorption]] from [[intestine]].
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑'''
 | 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
+* '''↓''' [[25-hydroxy vitamin D|25 Hydroxy vitamin D]]
 |-
 | colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''Chronic kidney disease'''
@@ Line 140: / Line 139: @@
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''↑'''
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* '''↓''' Glomerular flitration rate
+* '''↓''' [[Glomerular filtration rate]]
 |}

Hypoparathyroidism differential diagnosis: Difference between revisions

Revision as of 15:32, 3 October 2017

Overview

Differentiating Hypoparathyroidism from other Diseases

References

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