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Pseudohypoparathyroidism
Published in Pallavi Iyer, Herbert Chen, Thyroid and Parathyroid Disorders in Children, 2020
Ambika P. Ashraf, Todd D. Nebesio
Findings consistent with acute or chronic hypocalcemia include paresthesia, muscle cramps, tetany, hyperreflexia, or seizures. Hypocalcemia can clinically be detected as a positive Chvostek sign (twitching of facial muscles after tapping the facial nerve just in front of the ear) and/or Trousseau sign (carpal spasm after maintaining an arm blood pressure cuff at 20 mm Hg above the patient’s systolic blood pressure for 3 minutes).
Thyroid Hormones and Calcium Metabolism
Published in Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal, Principles of Physiology for the Anaesthetist, 2020
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal
Hypocalcaemia causes spontaneous twitching, muscle cramps, laryngospasm, bronchospasm, hyper-reflexia, prolonged QT interval and tingling and numbness. Clinical signs of hypocalcaemia include Chvostek sign (twitching of facial muscles elicited by tapping on facial nerve) and Trousseau sign (carpopedal spasm upon inflation of blood pressure cuff). The muscle twitching and tingling is caused by increased excitability of sensory and motor nerves because decreased extracellular Ca++ lowers the threshold potentials of nerves and muscles.
Disorders of calcium regulation
Published in Philip E. Harris, Pierre-Marc G. Bouloux, Endocrinology in Clinical Practice, 2014
The signs and symptoms of hypocalcemia affect many different tissues in the body (Table 11.7). Neuromuscular signs and symptoms can be very troubling to the patient and include tetany, cramping of the muscles, paresthesias, numbness and tingling especially around the mouth and face and in the extremities, seizures (focal or generalized), depressed mental status, choreoathetosis, and even organic brain syndrome. Both Trousseau and Chvostek signs can be elicited in hypocalcemic patients to determine whether there is evidence of neuromuscular irritability. Trousseau sign is elicited by inflating the blood pressure cuff for at least 3 min to ~20 mm Hg over the systolic blood pressure.34 When it is positive, painful carpal spasms involving the fingers of the tested hand occur. Chvostek sign is demonstrated by tapping the cheek over the facial nerve in front of the ear and just below the zygoma. A positive sign is twitching of the ipsilateral face. Cardiac signs include prolonged QT interval on the electrocardiography (ECG). Congestive heart failure can also occur if the abnormal serum [Ca2+] is profoundly low, usually for a very long time, or in individuals with underlying cardiac disease.34,60–62 Subcapsular cataracts may be seen in chronic hypocalcemia as well as papilledema. Full-blown pseudotumor cerebri can also be seen. The hair and nails are often dry and brittle.
A case of celiac disease presenting with celiac crisis: rare and life threatening presentation
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Rakshya Poudyal, Saroj Lohani, William B. Kimmel
A 20 year old male of mixed European descent with past medical history of Type 1 Diabetes and Hypothyroidism and vitamin D deficiency was called by his endocrinologist and told to go to emergency department after his labs showed severe hypocalcemia. His calcium was 5.8 mg/dl (normal range 8.6–10.3 mg/dl). His corrected calcium was 6.8 mg/dl and ionized calcium was 0.76 mmol/L (normal range 1.15–1.33 mmol/L). He had been complaining of generalized weakness for couple of weeks. Patient and his father reported history of bloating and swelling of feet. He denied any history of seizure like activity, nausea, vomiting, abdominal pain. He reported that his bowel movements were mostly 1–2 times a day light brown and formed. He had been on variable doses of magnesium for the last one year and would get loose bowel movements with high doses of magnesium. He was able to tolerate pasta without any symptoms. He denied history of weight loss, fever, chills. He had been taking calcium, magnesium and vitamin D supplement since his labs showed low calcium, magnesium and vitamin D levels one year ago. He was on insulin for Type 1 diabetes and levothyroxine for hypothyroidism. Family history was positive for hypothyroidism in both parents. Vital signs on admission revealed heart rate of 88/minute, respiratory rate of 18/minute, temperature of 98.4 F and blood pressure of 110/79 mm Hg. Physical exam was significant for 1+ bilateral lower extremity edema and positive Chvostek sign.
Autoimmune polyglandular syndrome type 1: a case report and brief review
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Ifeanyi Nwosu, Oreoluwa Oladiran, Chinyere Ogbonna-Nwosu, Anulika Anyata
On physical examination, he was in no acute distress. He was hypotensive with BP 89/67 and tachycardic with pulse rate of 115 bpm. Other vital signs were normal. Chvostek sign was negative and there was no thyromegaly on neck palpation. Oral examination showed multiple hyperpigmented lesions on the dorsum of his tongue (Figure 1) and multiple deformed and pitting finger nails in both hands (Figure 2). The remainder of the physical examination was unremarkable.