Indian Journal of Radiology Indian Journal of Radiology  

   Login   | Users online: 1826

Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size     

 

NEURORADIOLOGY Table of Contents   
Year : 2006  |  Volume : 16  |  Issue : 2  |  Page : 181-182
Extensive intracranial calcification in idiopathic hypoparathyroidism : Rare presentation in an adolescent


Department of Radodiagnosis, City hospital & Kasturba Medical Colllege, Mangalore-1, Karnataka, India

Click here for correspondence address and email
 

Keywords: Extensive intracranial calcification, Idiopathic hypoparathyroidism

How to cite this article:
Venugopal A, Acharya P, Kishore M S. Extensive intracranial calcification in idiopathic hypoparathyroidism : Rare presentation in an adolescent. Indian J Radiol Imaging 2006;16:181-2

How to cite this URL:
Venugopal A, Acharya P, Kishore M S. Extensive intracranial calcification in idiopathic hypoparathyroidism : Rare presentation in an adolescent. Indian J Radiol Imaging [serial online] 2006 [cited 2019 Nov 20];16:181-2. Available from: http://www.ijri.org/text.asp?2006/16/2/181/29083

   Introduction Top


Hypoparathyroidism is an endocrine disorder caused as result of congenital disorders, iatrogenic causes (eg, drugs, removal of the parathyroid glands during thyroid or parathyroid surgery, radiation), infiltration of the parathyroid glands (eg, metastatic carcinoma, Wilson's disease, sarcoidosis), suppression of parathyroid function, HIV/AIDS, or idiopathic mechanisms. Idiopathic Hypoparathyroidism is diagnosed when all the possible causes of hypoparathyrodism are ruled out. Hypoparathyroidism is well known to cause detectable basal ganglia calcification in most of the patients. It is also well known that extensive intracranial calcification caused by hypoparathyrodism is rare. Here we would like to present a case of idiopathic hypoparathyroidism which presented with extensive intracranial calcification.


   Case Report Top


A 14-year-old male patient presented as status epilepticus with history of seizures from the age of 9 yrs and was on treatment with anticonvulsants. Since three months the frequency of the seizures had increased, with no evidence of psychosis or altered mental status. On examination Positive Chvostek or Trousseau sign were present. Contrast enhanced spiral CT done showed bilateral extensive nonenhancing hyper dense lesions (calcifications) involving the thalamus, dentate nuclei, putamen, globus pallidus, caudate nucleus and sub-cortical white matter [Figure - 1],[Figure - 2],[Figure - 3]. Investigations revealed reduced serum levels of calcium and phosphorus. Serum magnesium levels and renal function tests were normal. Radio immunoassay (RIA) revealed reduced PTH levels. With these investigations and after ruling out other causes of hypoparathyrodism we suggested the possibility of idiopathic hypoparathyrodism.


   Discussion Top


Hypoparathyroidism is an endocrine disorder caused as result of congenital disorders, iatrogenic causes, infiltration of the parathyroid glands, suppression of parathyroid function, or idiopathic mechanisms[3]. In these cases either there will be apparent deficiency of PTH secretion or end-organ failure[4] .Idiopathic hypoparathyroidism is an uncommon condition of unknown etiology . Acquired and congenital hypoparathyroidism will have PTH levels which are either normal or undetectable, with hypocalcaemia whereas in idiopathic hypoparathyroidism both calcium and PTH levels are low[4]. In pseudo hypoparathyroidism PTH levels will be high with hypocalcaemia. In pseudopseudohypoparathyroidism with increased PTH level both serum calcium and phosphorus levels are normal[4]. Prevalence of hypoparathyroidism is equal in men and women and occurs in all age groups. Classical clinical presentation is with features of hypocalcaemia (Chvostek or Trousseau sign, tetany, seizures, cardiac failure)[1].

Radiologically hypoparathyroidism causes calcification most often in bilateral basal ganglia [1]. The most common site is often globus pallidus [2]. Calcification can also occur in cerebellum, sub cortical white matter, corona radiata and the thalamus. In skeletal survey calvarial thickening, soft tissue calcification, and premature closure of the epiphysis may or may not be present in all types of hypoparathyroidism [4]. Hypoparathyroidism commonly has mild or diffuse osteosclerosis[4]. Pseudo hypoparathyroidism, pseudo pseudo hypoparathyroidism classically will have metacarpal/metatarsal shortening and exostosis formation [4].Most commonly involved are the 1st and 4th meta carpal/tarsal bone. In idiopathic hypoparathyroidism none of the skeletal manifestations may be present at early stages.

The immediate treatment for all types is immediate calcium supplement with supplementation of PTH in cases of acquired hypoparathyroidism. Also one has to treat symptomatically for the seizures and other changes. This disease has a good prognosis if detected early and treated.[5]

 
   References Top

1.Case report: extensive brain calcification in hypoparathyroidism. Fulop M, Zeifer B. Am J Med Sci. 1991 Nov;302(5):292-5.  Back to cited text no. 1    
2.Intracranial bilateral symmetrical calcification on CT-scanning. A case report and a review of the literature. Vakaet A, Rubens R, de Reuck J, vander Eecken H. Clin Neurol Neurosurg. 1985;87(2):103-11.  Back to cited text no. 2    
3.Idiopathic hypoparathyroidism with extensive intracranial calcification associated with kinesogenic choreoathetosis. Girija AS. J Assoc Physicians India. 2000 Sep;48(9):938-9.  Back to cited text no. 3    
4.Hypoparathyroidism, pseudohypoparathyroidism, pseudopseudohypoparathyroidism, chapter metabolic and endocrine disease of the skeleton.by J.B.Vogler III and J.H.Kim -Diagnostic Radiology 4th edition volume three.  Back to cited text no. 4    
5.Extensive cerebral calcification in hypoparathyroidism. Litvin Y, Rosler A, Bloom RA. Neuroradiology. 1981;21(5):271-2.  Back to cited text no. 5    

Top
Correspondence Address:
M S Kishore
Department of Radiodiagnosis, K.M.C., Attavar, Mangalore-575001, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.29083

Rights and Permissions


    Figures

[Figure - 1], [Figure - 2], [Figure - 3]

This article has been cited by
1 Fahręs disease: An uncommon cause of intracranial Calcification in children
Nayek, K. and Pati, S. and Banerjee, A. and Bhattacharjya, S.
Journal of Nepal Paediatric Society. 2012; 32(1): 76-78
[Pubmed]
2 Brain calcinosis and seizures in an adolescent boy
Anwar-Ul-Haq, Ibrahim, S., Gulab, S., Saleem, T., Ishaque, S.
Clinical Pediatrics. 2010; 49(12): 1160-1163
[Pubmed]
3 Hypoparathyroidism diagnosed by neurological signs and widespread intracerebral calcifications
Sabau, M., Comanescu, A., Maghiar, T., Dinulescu, D.
Romanian Journal of Neurology/ Revista Romana de Neurologie. 2009; 9(1): 44-50
[Pubmed]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  


    Introduction
    Case Report
    Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed5799    
    Printed102    
    Emailed1    
    PDF Downloaded382    
    Comments [Add]    
    Cited by others 3    

Recommend this journal