Postgrad Med J 77:56 doi:10.1136/pmj.77.903.56c
  • Self assessment answers

A young man with seizures, abusive behaviour, and drowsiness

Q1: What is the diagnosis?

The diagnosis is idiopathic hypoparathyroidism with basal ganglia calcification. The serum PTH level is inappropriately low for the degree of hypocalcaemia. Hypocalcaemia could have been worsened by other factors (as mentioned below).

There was associated renal failure, probably from prerenal causes, as the patient was clinically dehydrated and hypotensive, with a low central venous pressure and a high urea to creatinine ratio. Renal ultrasound was normal.

Chronic renal failure with secondary hyperparathyroidism can be a cause of basal ganglia calcification,1 but there would be high circulating parathormone in that case.

Basal ganglia calcification is known to be associated with calcification of the cortex and cerebellum.2 In such cases the patient can present with neuropsychiatric manifestations. …

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