Hypocalcemic hyper-CK-emia in hypoparathyroidism

Ishikawa, Tatsuya; Inagaki, Hiroshi; Kanayama, Manabu; Manzai, Tomoko

doi:10.1016/s0387-7604(12)80333-0

Cited by 26 publications

(15 citation statements)

References 9 publications

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“…Virtually all previous analogous publications represent cases of IHP [1][2][3][4][5]7,8,12 . In one case with osteomalacia, myopathy and hypocalcaemia, increased CK and alkaline phosphatase values were noted 13 , but this is not a consistent finding in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…The late onset, idiopathic form of HP is often missed because patients usually adapt to gradually established chronic hypocalcaemia. Myopathy accompanied by raised muscle enzymes has been described in nine patients with longstanding hypocalcaemia due to hypoparathyroidism [1][2][3][4][5][6][7][8] . The suggested pathogenetic mechanisms of myopathy and increased muscle enzymes in some patients with hypoparathyroidism do not satisfactorily interpret this association.…”

Section: Introductionmentioning

confidence: 99%

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Hypoparathyroidism in a patient presenting with severe myopathy and skin rash. Case report and review of the literature

Syriou¹,

Kolitsa²,

Pantazi³

et al. 2005

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hypoparathyroidism in a patient presenting with severe myopathy and skin rash. Case report and review of the literature

Syriou¹,

Kolitsa²,

Pantazi³

et al. 2005

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“…In this cases, however, CK tends do be normal 7 , whereas in our case it was strikingly elevated. Since the first description by Wolf et al , there have been very few cases of hypocalcemic myopathy with an increased CK, and almost all of them were due to IHP 1,2,[8][9][10] , but this finding can also be observed in pseudohypoparathyroidism 11 .…”

Section: Discussionmentioning

confidence: 99%

“…Our patient, for example, had elevated CK levels with no evidence of tetany, and his Trousseau's and Chvostek's signs were negative. Another hypothesis is that hypocalcemia could induce functional alterations in the sarcolemma, leading to the release of CK and myoglobin 4,8 . Kruse 1 suggests that hypocalcemia can change the enzyme content of striated muscle with no significant morphologic or structural abnormalities.…”

Section: Discussionmentioning

confidence: 99%

Hypocalcemic myopathy without tetany due to idiopathic hypoparathyroidism: case report

Nora

Fricke

Becker

et al. 2004

Arq. Neuro-Psiquiatr.

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-Myopathy due to idiopathic hypoparathyroidism is very unusual. We report on a 30 years-old man referred with complaints of sporadic muscle pain and mild global weakness for 10 years. His physical examination showed normal strength in distal muscle and slightly weakness in the pelvic and scapular girdles with no atrophy. Deep muscle reflexes were slightly hypoactive. Trousseau's and Chvostek's signs were absent. He had bilateral cataract and complex partial seizures. His laboratory tests showed decreased ionised and total calcium and parathyroid hormone and increased muscle enzymes. EMG and muscle biopsy was compatible with metabolic myopathy. After treatment with calcium and vitamin D supplementation he showed clinical, neurophisiological and laboratorial improvement. In conclusion: patients with muscle symptoms, even when non-specific and with normal neurological examination, should have serum calcium checked, as myopathy due to idiopathic hypoparathyroidism, even being rare, is treatable and easy to diagnose.KEY WORDS: myopathy, hypocalcemia, hypoparathyroidism. Miopatia hipocalcêmica secundária a hipoparatireiodismo idiopático sem tetamia: relato de casoRESUMO -Miopatia secundária a hipoparatireidismo idiopático é enfermidade raramente descrita. Relatamos o caso de homem de 30 anos que procurou atendimento médico com queixas de dores musculares e discreta fraqueza há cerca de 10 anos. Ao exame físico apresentava leve diminuição de força na musculatura pélvica e escapular, sem atrofia, ou fraqueza distal. Os reflexos miotáticos fásicos eram hipoativos e não havia sinais de Trousseau ou Chevostek. Havia história de catarata bilateral e crises parciais complexas. Os exames laboratoriais demonstraram hipocalcemia, com diminuição do paratormônio, hiperfosfatemia e enzimas musculares elevadas. A EMG e a biópsia de músculo foram compatíveis com miopatia metabóli-ca. Após reposição de cálcio e vitamina D houve melhora clínica e neurofisiológica. Em conclusão: em pacientes com sintomas musculares, mesmo não específicos para miopatia ou com exame neurológico normal, devese dosar cálcio sérico, já que miopatia associada a hipoparatireoidismo é uma doença facilmente diagnosticada e tratável. PALAVRAS-CHAVE: miopatia, hipocalcemia, hipoparatireoidismo.Myopathy due to idiopathic hypoparathyroidism (IHP) is an extremely rare condition, with little more than 10 cases described in the literature, and its pathophysiology is not well established [1][2][3][4] . IHP is an infrequent disease of unknown aetiology, caused by insufficient secretion of parathyroid hormone (PTH). Its estimated prevalence in Japan is 7.2 cases per million individuals 5 . The reduced secretion of this hormone leads to hypocalcemia and hyperphosphatemia, due to the inhibition in calcium reabsorption in distal tubules and bone matrix, and also to the deficiency in the synthesis of 1,25-dihydroxyvitamin D. The clinical manifestations of IHP are multiple and affect mainly tissues of ectodermic origin. Among the most common findings in these patient...

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“…O aumento de enzimas musculares é um achado raro no hipoparatireoidismo (3)(4)(5) . Em alguns relatos os níveis de creatino quinase (CK) variam inversamente com as concentrações séricas de cálcio (6)(7)(8) . O aumento de CK foi atribuído à presença de tetania, porém, pode também ocorrer na sua ausência (2,7) .…”

Section: Discussionunclassified

Hipoparatireoidismo primário manifestando-se com aumento de enzimas musculares

Appenzeller¹,

Castro²,

Fernandes³

et al. 2005

Rev. Bras. Reumatol.

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RESUMOOs autores relatam o caso de um jovem de 18 anos de idade com fraqueza muscular generalizada, cãibras e crises convulsivas, tratado com corticosteróides por oito anos em decorrência de um diagnóstico de polimiosite, sem melhora clínica. Ao exame físico apresentava força muscular normal, ausência de atrofias musculares, diminuição de reflexos tendíneos profundos e presença INTRODUÇÃOA presença de fraqueza muscular com aumento de enzimas musculares sugere o diagnóstico de miopatia (1,2) . A investigação de um paciente que apresenta fraqueza muscular inclui hormônios tireoidianos, enzimas musculares e hepá-ticas, cálcio sérico e urinário. Muitas vezes a história nos fornece indícios quanto ao diagnóstico mais provável. Fraqueza muscular com atrofia muscular sugere o diagnóstico ABSTRACT

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Hypocalcemic hyper-CK-emia in hypoparathyroidism

Cited by 26 publications

References 9 publications

Hypoparathyroidism in a patient presenting with severe myopathy and skin rash. Case report and review of the literature

Hypoparathyroidism in a patient presenting with severe myopathy and skin rash. Case report and review of the literature

Hypocalcemic myopathy without tetany due to idiopathic hypoparathyroidism: case report

Hipoparatireoidismo primário manifestando-se com aumento de enzimas musculares

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