Hypoparathyroidism with Fahr’s syndrome: A case report and review of the literature

Abstract

BACKGROUNDHypoparathyroidism with basal ganglia calcification is clinically rare. Here, we report a case of Fahr’s syndrome due to hypoparathyroidism and review the literature in terms of etiology, clinical manifestation, diagnosis, and treatment.CASE SUMMARYA 62-year-old man experienced repeated twitching of both hands in recent 10 years. On July 28, 2017, the patient was admitted to our hospital due to slow response and speech difficulties. On medical examinations, he had a positive Chvostek sign, while no Albright’s hereditary osteodystrophy signs or history of neck surgery or radiation, and his family members had no similar medical history. Laboratory examinations revealed hypocalcemia, hyperphosphatemia, and low parathyroid hormone (PTH) levels. Computed tomography revealed basal ganglia calcification. Based on these investigations, a diagnosis of Fahr’s syndrome due to hypoparathyroidism was suggested. After receiving intravenous calcium gluconate to relieve symptoms, the patient continued to take oral calcium carbonate and calcitriol for treatment.CONCLUSIONThe possibility of hypoparathyroidism should be considered in patients with chronic hypocalcemia, recurrent tetany, and even neuropsychiatric symptoms. Hypoparathyroidism is a common cause of basal ganglia calcification. Therefore, it is recommended that blood calcium, phosphorus, and PTH levels should be measured in all individuals with basal ganglia calcification to exclude hypoparathyroidism.

From cranial nerve palsy to seizures—All the signs that lead to secondary Fahr’s syndrome

“…9,10 Hypoparathyroidism is a common cause of basal ganglia calcification, and its etiology can be idiopathic (uncommon condition characterized by the absence or atrophy of the parathyroid glands) or secondary (usually a complication of thyroid surgery). 5,11,12 As regards the present case, the patient had no history of neck surgery, neither there was evidence of an infectious disease. It were not found any vitamin deficiencies or signs of malnutrition.…”

“…Multiple clinical conditions are associated with intracranial calcifications, including infectious diseases (acquired immune deficiency syndrome, toxoplasmosis, cytomegalovirus, herpes simplex, brucellosis), genetic conditions (Fahr's disease, pseudohypothyroidism), vascular, toxic exposure (lead poisoning, hypervitaminosis D), autoimmune disease (systemic lupus), and endocrine disorders (calcium/phosphorus abnormalities) 9,10 . Hypoparathyroidism is a common cause of basal ganglia calcification, and its etiology can be idiopathic (uncommon condition characterized by the absence or atrophy of the parathyroid glands) or secondary (usually a complication of thyroid surgery) 5,11,12 …”

Idiopathic hypoparathyroidism induced fahr’s syndrome

“…Idiopathic hypoparathyroidism induced FS is diagnosed based on findings of hypocalcemia, hyperphosphatemia, and hypoparathyroid hormone with additional findings of calcium deposition in the basal ganglia seen most commonly on CT imaging. As previously mentioned, these effects on the basal ganglia result in abnormal neuropsychiatric motor activity [11].…”

A Unique Presentation of Fahr's Syndrome Secondary to Hypoparathyroidism

“…Mahmood et al reported a case of movement disorder in a patient with Fahr's syndrome due to hypoparathyroidism [ 6 ]. Zhou et al also highlighted a case of Fahr's syndrome due to primary hypoparathyroidism presenting with movement disorders [ 7 ]. Similarly, our patient had Fahr's syndrome secondary to hypoparathyroidism manifesting as aphasia and parkinsonian features, rarely reported in the literature.…”